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SYSTEMATIC      TREATISE 


ABORTION: 


EDWIN    M.    HALE,    M.D., 

PROFESSOR  OF  MATERIA  MEDICA  ASD  THERAPEUTICS  IN  HAHXEMAXX  MEDICAL  COLLEGE 
ETC.,  BTC. 


CHICAGO . 

C.    S.    HALSEY,    147    CLARK    STREET. 
1866. 


W  &  2  2 


Entered  according  to  Act  of  Congress,  in  the  year  1SGC, 

BY  C.  S.  HALSEY, 
In  the  Clerk's  Office  of  the  District  Court,  for  the  Northern  District  of  Illinois. 


CHURCH,  GOODMAS  AND  DONNELLEY,  PRINTERS,  51  and  53  LaSalle  Street,  Chicago. 


THIS 

VOLUME 

13 

INSCRIBED 

TO 

A.    E.    SMALL,   A.M.,   M.D., 

OF     CHICAGO : 

A     MOST     EXCELLENT     PHYSICIAN, 

ONE     OF     THE     BEST     OF     MEN, 

AND    TRUEST    OF    FRIENDS. 


PREFACE. 


IN  the  Eighth  Volume  of  the  North  American  Journal  of  Homoeopathy 
(1860),  an  article  appeared  bearing  the  title,  "Abortion:  its  Pre- 
vention and  Treatment,"  in  which  the  writer  ventured  to  call  the 
attention  of  his  professiqnal  colleagues  to  medicines  not  heretofore 
used  by  members  of  the  Homoeopathic  school,  and  which  he  believed 
to  be  of  considerable  value  as  remedial  agents  for  the  removal  of 
certain  abnormal  conditions  of  the  organs  of  generation,  which  are 
likely  to  cause  an  arrest  of  development,  or  premature  expulsion  of 
the  product  of  conception.  The  interest  that  this  article  aroused 
in  the  professional  mind  was  such  that  the  writer  felt  justified  in 
enlarging  and  amending  the  original  paper.  \i  was  then  issued  by 
the  present  publisher,  in  a  pamphlet  of  twenty-two  pages,  entitled 
"  The  Homoeopathic  Treatment  of  Abortion"  etc. 

This  small  brochure  was  prefixed  by  a  Prefatory  Letter  from  Dr. 
R.  Ludlam,  in  which  he  kindly  commended  it  to  the  notice  of 
Homoeopathic  physicians. 

That  edition  of  the  monograph  having  been  exhausted,  the  writer 
engaged  in  a  more  thorough  and  systematic  study  of  the  subject. 
Five  years  having  elapsed  since  the  appearance  of  the  original 
paper,  he  had  gained  increased  practical  experience  upon  the 
subject.  He  has,  therefore,  attempted  to  embody  these  results 
in  the  Treatise  herewith  presented  to  the  general  medical  profes- 
sion, and  especially  to  physicians  of  the  Homoeopathic  school. 

He  sincerely  hopes  this  volume  will  form  a  useful  addition  to 
our  medical  literature. 

CHICAGO,  April  2,  1866. 


CONTENTS. 


PAGE 

INTRODUCTION xiii 

PART  I.— STATISTICS  OF  ABORTION. 

Of  Foreign  Countries  •. 19 

Of  New  York  City 20 

Of  Boston ....*.  22 

Of  Chicago   , 23 

As  to  the  period  at  which  Abortion  occurs    25 

Of  Criminal  Abortion 27 

PART  II.— ETIOLOGY  OF  ABORTION. 

TABULAR  VIEW  OF  THE  CAUSES  OF  ABORTION 33 

SEC*  I. — PREDISPOSING  CAUSES. 

Plethora 35 

Anfemia  or  Chlorosis 35 

Scrofula 36 

Return  of  Menstrual  Crisis 36 

:  Zymotic  Diseases: 

Syphilis v 37 

Mercurialization 38 

Variola    38 

Asiatic  Cholera 39 

Yellow  Fever 39 

•'    SEC.  II. — LOCAL  CAUSES. 

Abnormal  Condition  of  the  Ovum  and  its  Appendages 39 

Moles 40 

Hydatids     41 

Fatty  deterioration  of  the  Chorion  and  Placenta 42 

Congestion  of  the  Placenta. 43 

Inflammation  of  the     "         43 

Placenta  Previa 44 

SEC.  III. — CENTRIC  CAUSES. 

Emotional 45 

Physical    45 

Medicinal      46 


Vlll.  CONTENTS. 

PAGE 

Galvanism 48 

Cerebro- Spinal-Meningitis 49 

SEC.  IV. — CONCENTRIC  CAUSES. 

Parotidean 55 

Thyroidean     56 

Mammary 56 

Gastric 56 

Dental 57 

Renal 57 

Vesical 57 

Rectal 57 

Vaginal 58 

Ovarian 58 

Uterine 59 

*•    SEC.  V. — FUNCTIONAL  DISEASES  OF  THE  UTERUS. 

Congestion 61 

Leucorrhoea    62 

"            Cervical  or  Mucous 64 

"                  "          Sequelae 65 

"            Vaginal  or  Epithelial 67 

Gonorrhoea 69 

SEC.  VI. — ORGANIC  DISEASES  OF  THE  UTERUS  AND  CERVIX. 

Ulceration  of  the  Cervix 71 

Simple  Granulating  Ulcer ^ 73 


Varicose 

Fissured 

Follicular 

Phagsedenic 

Corroding 

Cancerous 


76 

77 
79 
80 
80 
80 


Syphilitic                       "     80 

SEC.  VII. 

INDURATION  OF  THE  CERVIX  UTERI 82 

Displacements  of  the  Uterus   84 

Anteversion   84 

Prolapsus   84 

Retroversion 84 

Death  of  Embryo 87 

Coitus 87 

Instrumental  Irritation 88 

Ovarian 89 

"       Irritation 89 

"       Congestion   90 

"       Inflammation     90 


CONTENTS.  IX. 

SEC.  VIII. 

PAGE 

MEDICINAL  CAUSES    90 

PART  III.— GENERATION : 

SYMPTOMS,  DIAGNOSIS,  PATHOLOGY.  MECHANISM  AND  PROGNOSIS  OP 

ABORTION. 

SEC.  I. — GENERATION. 

To  date  of  Placental  Attachments , 115 

"  Viability 117 

"  Delivery 118 

Dimensions  and  Weight  of  the  Foetus  at  the  different  periods 

of  Uterine  Life 119 

SEC.  II. — SYMPTOMS  OF  ABORTION. 

Premonitory 123 

Actual 124 

Chills : 124 

Pain 125 

Haemorrhage 127 

Fever 130 

Complications 131 

Discharges 131 

Subsequent 131 

SEC.  III. — DIAGNOSIS  OF  ABORTION. 

Metritis 134 

Peritonitis 135 

Dysmenorrhcea 135 

Dysentery 135 

Congestion  of  Uterus    136 

Hydrorrhcea 137 

Haemorrhage 138 

Retention  in  Utero  of  the  Ovum  and  Appendages 140 

SEC.  IV. — PATHOLOGY  AND  MECHANISM  OF  ABORTION. 

Process  of  Abortion 142 

After  Conception 1 43 

"      twenty  days  to  the  third  month 143 

At  sixth  month 146 

SEC.  V. — PROGNOSIS  OF  ABORTION. 

When  favorable 148 

"       unfavorable 1 49 

Natural  abortions 150 

Immediate  consequences 151 

Remote  " ,     ,  151 


X.  CONTENTS. 

PART  IV.— TREATMENT  OF  ABORTION. 

SEC.  I. — PREVENTIVE  TREATMENT. 

PAGE 

Of  Plethora 155 

Anaemia  or  Chlorosis   159 

Scrofula 162 

Return  of  Menstrual  Crisis 162 

Of  Zymotic  Diseases: 

Syphilis    163 

Mercurialization     164 

Variola    164 

Scarlatina 166 

Diphtheria    168 

Cholera 170 

SEC.  II. — OF  LOCAL  OR  ORGANIC  DISEASES. 

Malformation  of  the  Ovum  171 

"      .         "       Membranes 171 

Placenta  Previa 172 

Organic  Disease  of  Placenta 173 

Fatty  Degeneration 173 

Hydatid         "             173 

Calcareous    "            175 

Molar             " 175 

SEC.  III. — OF  REFLEX  CAUSES. 

Centric  176 

Emotion,  Fright,  etc 176 

Blows,  Injuries,  etc 177 

Medicinal  178 

Concentric 178 

Parotidean  Irritation 178 

Thyroidal  179 

Mammary  179 

Dental  180 

Gastric  182 

Rectal  183 

Vesical  * 186 

Vaginal 187 

Hysterical 189 

Epilepsy 189 

Falls,  Jumping,  Blows,  etc 189 

SEC.  IV. — OF  FUNCTIONAL  DISEASES  OF  THE  UTERUS. 

Congestion • 191 

Inflammation 192 

Leucorrhrea 192 

Cervical  .,  .192 


CONTENTS.  XI. 

PAGE 

Vaginal 194 

Gonorrhoea    197 

SEC.  V. — OF  ULCERATION  OF  THE  Os  AND  CERVIX  UTERI. 

Simple  Granulating  Ulcer 204 

Varicose  "        204 

Fissured  "        : 205 

Follicular  » 206 

Phagsedenic  "        206 

Syphilitic  "        208 

Resume1 209 

Diphtheria 209 

Ovarian  Diseases 211 

SEC.  VI. — OF  UTERINE  DISPLACEMENTS. 

Prolapsus 213 

Anteversion 214 

Retroversion  . 214 

SEC.  VII. — REMEDIAL  TREATMENT. 

Medicinal 217 

Mechanical 224 

SEC.  VIII. 

CONDUCT  OF  THE  PHYSICIAN 234 

SEC.  IX. 

EXAMINATION  OF  THE  PATIENT 237 

SEC.  X. 
MANAGEMENT  OF  LABOR 240 

SEC.  XI. — SEQUELA  OF  ABORTION. 

Post-partum  Treatment    248 

Postural 248 

Dietetic 251 

Medicinal    252 

Of  Pelvic  Cellulitis    253 

Hypertrophy  of  the  Uterus     253 

Fistula 253 

Inflammation  of  the  Uterus    253 

Puerperal  Metritis 254 

"  Peritonitis 254 

Phlebitis    254 

Dropsy 254 

Paralysis    254 

Mental  Aberrations 254 

Chronic  Menorrhagia 255 

Mechanical  Treatment 256 

Of  Prolapsus 256 

Retroversion..  , .  256 


Xll.  CONTENTS. 

PART  V.— OBSTETRIC  ABORTION. 
SEC.  I. — OBSTETRIC  ABORTION. 

PAGE 

Necessity  of  Premature  Labor 263 

Methods  employed — Stillette 271 

Sponge-tent 271 

Caoutchouc  Bags    271 

Tampon   272 

Colpeurynteur    273 

"Water-douche 273 

Ergot 275 

Cupping-glasses 275 

Galvanism 277 

SEC.  II. — F(ETAL  ABORTION*. 

Methods  employed  280 

Flexible  Bougie 281 

Catheter 281 

SEC.  III. — EMBRYONIC  ABORTION. 

Methods  employed 284 

Flexible  Catheter 284 

Uterine  Sound 287 

Injections 288 

Abortion  Forceps 288 

SEC.  IV. — OVTILAR  ABORTION. 

What  it  is 290 

Utopian  Theories 291 

Duty  of  the  Physician 292 

Different  methods 293 

Theory  of  Impregnation    . 295 

Character  of  Spermatozoa 299 

Prophylaxis  of  Conception — agents  employed 303 

Tabular  View  of  Uterine  Contents  and  Synopsis  of  Treatment  309 

PART  VI.— JURISPRUDENCE  OF  ABORTION. 
SEC.  I. — CRIMINAL  ABORTION. 

A  Lecture  by  A.  E.  Small,  M.D 313 

"           Charles  Woodhouse,  M.D 320 

Laws  of  the  European  Countries 321 

"            different  States 323 

GENERAL  INDEX  . .              .  339 


USTTEODTJCTION. 


THE  term  ABORTION,  is  derived  from  the  Latin  word  aborto,  which 
means  literally  —  to  bring  forth  before  the  time:  This  broad  defini- 
tion allows  of  no  restriction,  aside  from  the  one  given  in  the  literal 
rendering.  The  premature  expulsion  of  the  contents  of  the  gravid 
uterus  at  any  date  prior  to  the  end  of  the  ninth  month,  or  the 
normal  expiration  of  pregnancy,  is  an  abortion.  In  this  work,  the 
term  has  therefore  been  used  in  its  broadest  sense  ;  but,  as  will 
be  seen,  I  have  divided  the  period  of  pregnancy  into  three  natural 
divisions,  based  on  the  condition  of  the  placenta  and  the  foatus. 
Four  kinds  of  abortion  are  treated  of,  namely:  (1)  OVTJLAR,  when 
the  ovum  is  lost  before  it  is  impregnated.  (2)  EMBRYONIC,  when 
the  impregnated  ovum  is  expelled  before  the  placenta  has  formed 
its  uterine  attachment.  (3)  FCETAL,  when  the  expulsion  occurs 
after  the  last  date,  and  before  the  viability  of  the. child;  and  (4) 
when  the  child  is  born  capable  of  living,  or  viable,  but  before  the 
end  of  a'  normal  pregnancy. 

This  is  not  an  arbitrary  plan,  because  it  is  founded  on  natural 
changes  and  certain  periods,  which  are  well  recognized  in  physio- 
logical science.  Such  an  arrangement  greatly  facilitates  a  study 
of  the  subject  in  a  methodical  manner. 

Hitherto  no  complete  and  systematic  treatise  on  Abortion  has 
appeared  in  the  literature  of  any  school  of  medicine. 

The  Allopathic  branch  of  the  profession,  in  which  we  would 
naturally  look  for  a  work  on  this  subject,  possesses  but  one  volume, 
which  treats  of  it  in  a  monographic  manner. 

Dr.  Whitehead's  work  on  "Abortion    and    Sterility"  was   pub- 


XIV.  INTRODUCTION. 

lished  in  1854.  "While  it  is  a  valuable  work  of  reference  on  certain 
points,  it  is  lacking  in  systematic  completeness.  It  contains  some 
suggestive  statistics,  and  an  excellent  elucidation  of  many  of  the 
causes  of  abortion,  with  their  Allopathic  treatment ;  but  beyond 
this,  the  author  does  not  extend  the  work.  No  mention  is  made 
of  the  intermediate  and  remedial  treatment  of  the  accident  itself, 
or  of  its  numerous  and  important  sequelae. 

The  obstetrical  works  of  Churchill,  Ramsbotham,  Tyler  Smith, 
Simpson,  Cazeaux,  Hodge,  Meigs,  Bennett,  Bedford,  Gardner  and 
others  (Allopathic);  King,  Scudder,  and  Beach,  (Eclectic);  and 
Jahr,  Leadam,  Pulte,  Loomis,  Small,  Marcy,  Ludlam  and  others 
(Homoaopathic);  all  contain  much  in  relation  to  this  subject. 

I  have  drawn  freely  from  all  these  authorities,  selecting  the 
practical  and  useful,  and  rejecting  all  that  was  irrelevant.  Of  all 
medical  writers,  Cazeaux  seems  to  me  to  have  treated  the  subject 
of  abortion  in  the  most  systematic  manner. 

The  various  periodicals  of  our  school  have  been  examined  for 
clinical  experience  relating  to  the  treatment  of  this  accident. 
Considerable  practical  information  on  this  point  has  been  commu- 
nicated to  me  by  my  professional  friends.  I  am  especially  under 
many  obligations  to  Dr.  R.  Ludlam,  Professor  of  Obstetrics  and 
Diseases  of  Women  and  Children  in  Hahnemann  Medical  College, 
for  his  kind  assistance  while  in  the  preparation  of  this  work,  and 
also  for  the  use  of  his  large  obstetrical  library,  containing  many 
rare  and  valuable  volumes. 

I  am  obliged  to  state,  however,  that  on  many  points  of  import- 
ance relating  to  the  treatment  and  induction  of  abortion  I  have  had 
to  rely  almost  wholly  upon  my  own  experience,  and  to  ascertain 
the  most  practical  and  useful  facts  by  careful  experiment  and 
patient  investigation. 

Abortion  has  grown  to  be  a  subject  of  such  importance  to  the 
medical  man,  that  its  consideration  should  no  longer  be  confined  to 
the  works  devoted  to  obstetrics  and  diseases  of  women,  wherein  it 
can  but  be  treated  of  in  a  manner  not  sufficiently  complete  to  sat- 
isfy the  student  or  investigating  practitioner. 


INTRODUCTION.  XV. 

It  must  strike  every  observant  aud  thinking  physician  that  the 
day  for  large  treatises,  on  such  broad  subjects  as  "Practice," 
"  Materia  Medica,"  "Surgery,"  "Obstetrics  and  Diseases  of  Wo- 
men," has  gone  by.  No  medical  writer  can  do  justice  to  the  range 
of  subjects  naturally  included  in  any  one  of  the  above  titles,  if  he 
is  confined  to  one  or  even  two  volumes.  Nothing  short  of  an  ency- 
clopredia  of  one  of  the  above  subjects  would  satisfy  the  require- 
ments of  the  age,  and  as  an  encyclopaedia  is  made  up  of  separate 
monographs,  it  will  greatly  enhance  the  value  of  medical  literature 
if  a  series  of  exhaustive  monographs  appear  which  shall  do  away 
with  the  necessity  for  such  ponderous  works.  Moreover,  the  accu- 
mulations of  such  valuable  material  relating  to  any  one  subject 
pertaining  to  practical  medicine  has  become  so  extensive,  and 
withal  so  scattered  through  the  books,  journals  and  other  periodi- 
cals, that  it  is  the  duty  of  the  medical  writer  to  collect  the  material 
together,  and  put  it  in  such  a  form  as  to  be  most  available  to  the 
student  or  practitioner. 

To  this  end  the  writer  of  this  volume  has  directed  his  labors.  • 
He  does  not  claim  to  present  much  original  matter,  although  his 
observations  and  experience  have  enabled  him  to  increase  somewhat 
the  common  stock  of  information  relative  to  the  etiology  and  treat- 
ment of  the  accident. 

He  has  drawn  freely  from  all  the  standard  medical  works  of  the 
day,  and  from  all  sources  which  seemed  to  him  reliable.  Medical 
facts  are  common  property,  and  it  is  not  necessary  to  give  further 
credit  to  authors  and  observers,  than  is  given  in  the  pages  wherein 
mention  is  made  of  the  sources  of  information. 

This  work  is  intended  in  no  respect  for  public  circulation,  and 
the  author  would  be  sorry  to  think  it  should  ever  be  perused  by 
the  prurient  and  immoral. 

In  order  to  render  the  work  as  complete  as  possible,  it  has  been 
necessary  to  mention  the  various  methods  to  be  made  use  of  for  the 
induction  of  abortion  for  legitimate  purposes.  If  this  information 
shall  be  abused,  and  used  for  unlawful  purposes,  the  blame  must 
rest  where  it  really  belongs. 


XVI.  INTRODUCTION. 

If  I  have  not  given  minute  indications  for  the  use  of  each  remedy 
mentioned  in  the  following  pages,  it  is  because  of  the  impossibility 
of  so  doing  in  a  work  of  this  kind,  without  swelling  it  to  an  inordi- 
nate size.  The  symptoms  of,  and  special  indications  for,  the  use  of 
each  medicine  can  be  found  in  the  several  works  on  Materia  Medica, 
belonging  to  the  Homoeopathic  school. 

I  believe  that  no  physician  in  whose  hands  this  work  may  fall, 
will  consider  the  volume  a  superfluous  addition  to  our  literature. 


PART     I. 


STATISTICS  OF  ABORTION. 


STATISTICS  OF  ABORTION. 

IT  will  be  appropriate,  before  we  enter  upon  the 
consideration  of  the  causes,  pathology,  treatment,  etc., 
of  Abortion,  that  we  shall  make  ourselves  acquainted 
with  the  statistics  having  a  direct  bearing  upon  the 
subject. 

The  first  question  which  presents  itself — Is  Abortion 
constantly  increasing? — is  so  important  that  we  shall 
present  the  statistics  in  as  complete  a  manner  as  is  con- 
sistent with  the  plan  of  this  work. 

The  following  statistics  are  taken  from  an  elaborate 
work*  by  Horatio  B.  Storer,  M.  D.,  of  Boston.  Wri- 
ting of  the  frequency  of  abortion  in  our  own  country, 
he  says : 

"Statistics  in  this  country  are  yet  so  imperfect  that 
we  are  necessitated  to  a  process  of  deduction.  *  *  * 
If  we  find  that  in  another  country  living  births  are 
steadily  lessening  in  proportion  to  the  population  and 
to  its  increase — that  natural  and  preventive  causes  are 
insufficient  to  account  for  this — while  the  proportion 
of  still  births  and  of  known  abortions  is  constantly 
increasing,  and  these  last  bear  an  evident  yet  increasing 
ratio  to  the  still-births ;  that  in  this  country  the  de- 
crease of  living  births,  and  the  increase  of  still-births, 
are  in  much  greater  ratio  to  the  population,  and  the 
proportion  of  premature  births  is  constantly  increasing ; 
•and  that  these  relations  are  constantly  and  yearly  more 
marked,  we  are  justified  in  supposing  that  abortions  are 

*  Criminal  Abortion  in  America. 


20  HALE    ON    ABOETION. 

at  least  as  frequent  with  us,  and  probably  more  so. 
In  many  countries  of  Europe  it  has  been  ascertained 
that  the  '  fecundity'  of  the  population,  or  the  rate  of 
its  annual  increase  is  rapidly  diminishing. 

"  In  Sweden  it  has  lessened  by  a  fifth ;  in  Prussia, 
by  a  fourth  ;  in  Denmark  and  England,  by  a  third,  and 
in  Russia,  Spain,  Germany  and  France,  by  a  half,  in  a 
single  c&ntwry  ! 

"  In  four  departments  of  France,  among  which  are 
two  of  the  most  thriving  of  Normandy,  the  deaths  ac- 
tually exceed  the  births ! 

"  Again,  as  might  have  been  expected,  we  find  that 
the  proportion  of  still-births,  in  which  we  must  include 
abortions,  as  has  hitherto  been  done,  however  improp- 
erly, in  all  extensive  statistics,  is  enormous,  and  is 
steadily  increasing ;  and  while  the  proportion  of  still-, 
births  to  the  whole  number  is  greatly  increasing  in 
Paris,  as  is  the  number  of  known  abortions.  *  *  At 
the  Morgue,  which  represents  but  a  very  small  fraction 
of  the  foetal  mortality  of  Paris,  and  in  this  matter 
almost  entirely  crime,  there  were  deposited  during  the 
eighteen  years  preceding  1855,  a  total  of  1115  foetuses, 
of  which  423  were  at  the  full  term,  and  692  were  less 
than  nine  months,  and  of  these  last,  519,  or  five-sixths, 
were  not  over  six  months,  a  large  proportion  of  them 
showing  decided  marks  of  criminal  abortion. 

"  We  now  turn  to  our  own  country,  to  which  the  city 
of  New  York  holds  much  the  same  relation  that  Paris 
holds  to  France. 

"  Since  1805,  when  returns  were  first  made  to  the 
Registry  of  New  York,  the  number,  proportionate  as 
well  as  actual  of  foetal  deaths,  has  steadily  and  rapidly 
increased.  With  a  population,  at  that  time,  (1805)  of 
76,770,  the  number  of  still  and  premature  births  was 
47;  in  1849,  with  a  population  at  450,000,  the  number 
had  swelled  to  1320." 

In  brief,  while  the  ratio  of  fcetal  deaths  to  the  popu- 
lation was,  in  1805,  1  to  1633.40,  in  1849  it  was  1  to 
340.90 ;  and  when  we  consider  that  a  large  proportion 


STATISTICS    OF   ABORTION.  21 

of  the  reported  premature  births  must  always  be  from 
criminal  causes ;  and  that  though  almost  all  the  still- 
births at  the  full  time,  even  from  infanticide,  are  ne- 
cessarily registered,  but  a  small  proportion  of  the 
abortions  and  miscarriages  occurring  are  ever  reported 
to  the  proper  authorities,  it  will  be  apparent  that  at 
the  present  moment  the  abortion  statistics  of  New  York 
are  far  above  those  of  1849.  This  the  following  table 
will  show,  as  well  as  the  fact  that  the  ratio  is  steadily 
increasing : 

Total  mortality.        Still -birth.  Ratio. 

1804  to  1809  -  -  -    13,128  349  I  to  37.6 

1809  to  1815  -  -  -    14,011  533  1  to  26.3 

1815  to  1825-  -  -    34,798  1,818  1  to  19.1 

1825  to  1835  -  -  -    59,347  3,744  1  to  15.8 

1835  to  1855  -  -  -  289,786  21,702  1  to  13.3 

1856                -  -  -    21,658  1,942  1  to  11.1 

"  The  frequency  of  abortions  and  premature  births 
reported  from  the  practice  of  physicians,  and  thus  to  a 
certain  extent,  but  not  entirely,  likely  to  be  of  natural 
or  accidental  origin,  is  as  follows : 

"In  4 1,699  cases  registered  by  Collins,  Beatty,  La 
Chapelle,  Churchill,  and  others,  there  were  .530  abor- 
tions and  miscarriages.  Here  all  the  abortions  were 
known :  their  proportion  was  1  to  78.5. 

"In  New  York,  from  1854  to  1857,  there  were  48,- 
323  births  at  the  full  time  reported,  and  1,196  prema- 
ture. Here  all  the  abortions  were  not  known,  probably 
but  a  very  small  fraction  of  them :  the  proportion  was 
1  in  40.4.  In  the  seventeen  years  from  1838  to  1855 
there  were  reported  17,237  still-births  at  the  full  time, 
and  2,710  still  prematurely;  the  last  bearing  the  pro- 
portion of  1  to  6.3.  In  the  nine  years  from  1838  to 
1847,  there  were  632  premature  still-births,  and  6,445 
still  at  the  full  time :  a  yearly  average  of  1  in  10.2.  In 
the  eight  years  from  1848  to  1855,  there  were  2,078 
premature  still-births,  and  10,792  still  at  the  full  time : 
an  average  of  1  in  5 ;  while  in  1856  there  were  387 
still  prematurely  and  1,556  at  the  full  time,  or  1  in  4.02. 


22  HALE    ON    ABORTION. 

"From  these  figures  there  can  be  drawn  but  one 
conclusion — that  criminal  a*bortion  prevails  to  an  enor- 
mous extent  in  New  York,  and  that  it  is  steadily  ami 
rapidly  increasing.  *  We  cannot  refer/  was  well  said 
by  a  former  Inspector  of  that  city,*  '  such  a  hecatomb 
of  human  offspring  to  natural  causes.' " 

The  same  statistics  also  shew  that  the  reported  i-arlij 
abortions,  of  which  the  greater  number  of  course  escape 
registry,  bear  the  ratio  to  the  living  births  of  1  in  40, 
while  elsewhere  they  are  only  1  in  78.5 :  and  finally, 
that  early  abortions,  bearing  the  proportion  to  the  still- 
births at  the  full  time  of  1  in  10.2  in  1846,  had  increased 
to  1  in  4.2  in  1856. 

Almost  doubling,  therefore,  as  does  New  York,  the 
worst  of  those  fearful  ratios  of  foetal  mortality  existing 
in  Europe,  it  is  not  strange  that  our  metropolis  has 
been  held  up,  even  by  a  Parisian,  to  the  execration  of 
the  world  :  "  On  le  voit  (1'avorternent),"  says  Tardieu, 
"  en  Amerique,  dans  une  grande  cite  comme  New  York, 
constituer  une  industrie  veritable  et  non  poursuivie." 

"  In  this  description  of  New  York,"  says  Dr.  Storer, 
"  we  have  that  of  the  country." 

"  In  Boston,  which  for  morals  is  supposed  to  compare 
favorably  with  any  city  of  its  size  in  the  Union,  un- 
doubtedly more  than  a  hundred  still-births  yearly  escape 
being  recorded ;  a  large  proportion  of  which,  no  doubt, 
results  from  criminal  abortion." 

In  the  State  of  Massachusetts  it  appears  that  during 
the  fourteen  years  and  eight  months  preceding'  1855, 
there  were  recorded  4570  still-births,  and  11,716  pre- 
mature births  and  abortions,  the  ratio  being  one  abor- 
tion to  three  still-births ;  or,  in  other  words,  it  would 
appear  from  the  statistics  quoted,  that  the  comparative 
frequency  of  abortions  in  Massachusetts  is  thirteen  times 

•Report  of  1849. 


STATISTICS   OF  ABOKTION.  23 

as  great  as  in  the  worst  statistics  of  tlie  city  of  New 
York ! 

It  must  not  be  forgotten  that  while  nearly  every 
still-birth  at  the  full  time  is  necessarily  recorded,  there 
must  be  but  very  few  registrations  of  the  premature 
births  and  abortions  actually  occurring.  Few  persons 
could  have  believed  possible  the  existence  of  such 
frightful  statistics.  They  should  call  the  attention  of 
the  whole  medical  and  legal  world  toward  some  plan  to 
arrest  such  awful  destruction  of  embryo  human  life. 

In  the  great  city  of  Chicago  no  registration  of  the 
births  has  ever  been  made  ;  nor  do  the  physicians  make 
any  returns  relating  to  the  still-births,  miscarriages,  etc. 
This  is  much  to  be  regretted  on  many  accounts.  It 
does  not  do  credit  to  the  municipal  authorities,  to  the 
influential  citizens,  nor  to  those  physicians  of  the  domi- 
nant school,  who  are  supposed  to  have  influence  with 
those  in  power.  It  is  alleged  as  an  apology  for  this 
omission  of  a  civil  duty,  that  the  State  legislators  have 
never  passed  a  law  of  Registration  of  Births,  etc. ;  but 
this  is  no  valid  excuse,  when  it  is  in  the  power  of  the 
city  authorities  to  pass  an  ordinance  which  would  an- 
swer every  purpose  of  such  a  law. 

To  the  above  statistics  of  the  frequency  and  increase 
of  abortions,  I  will  add  those  of  Dr.  Whitehead,*  who 
asserts  that  "  the  number  of  pregnancies  which  each 
woman  experiences,  during  the  existence  of  herprocre- 
ative  aptitude,  is  about  twelve  ,  or  one  in  every  twenty 
months.  This  includes  abortions,  false  conceptions, 
premature  deliveries,  and  all  having  an  'unsuccessful 
issue,  the  average  amount  of  which  will  be  rather  more 
than  one  and  a  half  for  each  individual ;  or  it  may  be 

*  On  Abortion  and  Sterility,  page  198. 


24  HALE   ON    ABORTION. 

stated,  as  a  general  rule,  that  every  seventh  pregnancy 
has  a  premature  termination.  These  conclusions  have 
been  drawn  from  the  subjoined  facts. 

"  Two  thousand  married  women  in  a  state  of  preg- 
nancy, admitted  for  treatment  at  the  Manchester  Lying- 
in  Hospital,  during  parts  of  the  years  1845  and  1846, 
were  interrogated  in  rotation  respecting  their  existing 
condition  and  previous  history.  Their  average  age  at 
the  time  of  inquiry  was  a  small  fraction  below  thirty 
years.  The  sum  of  their  pregnancies  already  termi- 
nated was  8681,  or  4.38  for  each,  of  which  rather  less 
than  one  in  seven  had  terminated  abortively.  But  as 
abortion  occurs  somewhat  more  frequently  during  the 
latter  than  in  the  first  half  of  the  child-bearing  period, 
the  real  average  will  consequently  be  rather  more  than 
one  in  seven.  Of  the  individuals  submitted  to  inquiry, 
1253  had  not  then  suffered  abortion.  The  average  age 
of  these  was  28.62  years  ;  the  sum  of  their  pregnancies 
was  3906,  or  3.11  for  each  person.  The  remaining  747 
had  already  aborted  once  at  least,  and  some  oftener. 
Their  average  age  was  32.08  years.  The  sum  of  their 
pregnancies  was  5775,  or  6. 37;  that  of  their  abortions 
1222,  or  1.63  for  each  person.  From  the  preceding 
statements  it  appears  that  more  that  thirty-seven  out  of 
every  hundred  mothers,  experience  abortion  before  they 
attain  the  age  of  thirty  years." 

Dr.  Whitehead's  observations  do  not  accord  with  the 
popular  idea,  that  early,  especially  first  pregnancies, 
have  more  frequently  a  premature  termination  than 
those  which  come  after.  He  is  inclined  to  believe  that 
the  third  and  fourth,  and  subsequent  pregnancies,  and 
one  or  two  of  the  last — namely,  those  which  occur  near 
the  termination  of  the  fruitful  period — are  most  com- 
monly unsuccessful. 


STATISTICS    OF    ABORTION.  25 

At  what  period  of  pi^egnancy  does  abolition  most  fre- 
quently occur  f 

The  following  table,  copied  from  Whitehead,  throws 
some  light  on  this  question.  It  will  be  noted  that  the 
abortions  here  referred  to,  were  those  which  were  sup- 
posed to  occur  from  diseased  conditions  of  the  mother 
or  foetus.  Hereafter  the  subject  of  criminal  abortions 
will  be  referred  to.  ABORTION  (which  term  is  here  used 
in  its  most  extensive  signification)  may  occur  at  any 
period  of  utero-gestation.  It  will  be  seen  that  it  is 
much  more  common  at  some  stages  of  the  process  than 
at  others,  and  is  attended  with  different  degrees  of 
danger,  according  to  the  circumstances  under  which  it 
occurs,  the  nature  of  the  exciting  cause  being  the  most 
important.  When  it  takes  place  before  the  end  of  the 
sixth  month,  it  is  invariably  fatal  to  the  offspring,  either 
before  birth,  or  in  a  short  time  after  ;  and  at  any  period 
before  the  completion  of  the  process,  it  is  more  or  less 
injurious  to  its  well-being.  Instances  are  on  record, 
hpwever,  of  children  born  during  the  early  part  of  the 
seventh  month,  having  lived  in  the  enjoyment  of  toler- 
able health  and  constitutional  vigor  to  a  mature  age. 

"  Abortion  is  at  all  times  fraught  with  danger  to  the 
mother,  and  sometimes  attended  with  fatal  consequences. 
I  give  in  the  following  table  the  respective  periods  of 
602  cases  of  abortion,  which  have  occurred  under  my 
own  immediate  observation.  It  may  be  noticed  that 
each  figure  in  the  first  column  embraces  a  period  of 
four  weeks,  extending  from  a  fortnight  before  to  the 
same  length  of  time  after  the  month  indicated  ;  and  as 
abortions  happening  earlier  than  the  seventh  week  of 
uterine  life  are  so  frequently  and  so  nearly  simulated, 
both  in  married  and  unmarried  females,  by  certain  ute- 
rine discharges,  the  result  of  disordered  menstruation, 


26 


HALE    ON    ABORTION. 


events  said  to  have  taken  place  at  this  early  period, 
except  those  wherein  the  escape  of  an  ovum  was  un- 
doubtedly found,  have  not  been  included  in  the  report." 

TABLE 

Showing  the  Period  of  Pregnancy  at  which  Abortion 
occurred  in  602  cases,  the  relative  number  of  Still- 
born and  giving  Children,  and  the  number  living  at 
the  end  of  a  month  after  birth. 


Period  of  pregnancy  at  which  abortion 
occurred. 

Number  of 
births  at  each 
period. 

Number  still 
born. 

Number  liv- 
ing at  birth 

Number  liv- 
ing at  end 
of  a  month 

2  months  

35 

275 
147 
30 
32 
55 
28 

24 
38 
23 

8 
17 
5 

0 
3 
1 

3      "        

4      "        

5      "        

6      "        

7      «        

8      "        

Total  

602 

85 

30 

4 

"The  foetus  of  six  months'  growth  is  generally  consid- 
ered viable.  Of  the  eight  indicated  in  the  table,  as 
having  been  born  alive,  when  born  at  this  period,  seven 
perished  within  six  hours  after'  birth,  and  one  only 
attained  to  the  age  of  ten  days.  Of  the  seventeen  born 
alive  at  seven  months,  the  majority  lived  over  several 
days,  and  a  few  to  the  end  of  the  third  and  fourth 
week.  Three  still  survive,  the  youngest  of  whom  is 
now  aged  nineteen  months." 

Whitehead  does  not  mention  the  possibility  or  proba- 
bility of  an  abortion  occurring  at  the  forst  month,  or 
even  at  the  third  week  of  pregnancy.  Yet  it  must  be 
admitted  by  those  who  have  investigated  the  causes  of 
abortion,  that  it  is  by  no  means  improbable,  and  very 
possible,  for  the  abortions  which  occur  at  that  early 
period  to  outnumber  those  of  any  other  month. 


STATISTICS    OF    ABORTION".  27 

If  any  disease  of  the  uterus  or  contiguous  organs,  or 
any  constitutional  irritation  sufficient  to  cause  abortion 
exists,  such  causes  are  more  likely  to  induce  abortions  at 
the  FIKST  month  than  at  any  other  period.  « 

Let  us  consider  the  matter  logically..  Intimately 
connected  with  the  subject  above  treated  of,  is  that  of 
criminal  abortion,  and  the  period  of  pregnancy  at  which 
it  generally  occurs. 

From  Dr.  Storer's  work  we' learn  that  "  It  was  Orfila's 
opinion  that  criminal  abortion  was  most  frequent  in  the 
first  two  months  of  pregnancy.     This  would  naturally 
have  been  supposed  to  be  the  case,  as  then  some  doubt 
always  might  obtain  regarding  its  existence,  and  the 
excuse  that  the  measures  resorted  to  were  for  the  pur- 
pose of  preventing  ill  effects  from  an  abnormal  men- 
strual suppression,  would  be  more  available.  Devergie, 
on  the  other  hand,  was  inclined  to  put  the  limits  of 
greater  frequency  at  from  three  months  to  four  and  a 
half;    while  Briarid  and  Chandler  thought  the  crime 
more  common  in  the  third  month  than  the  fifth,  and 
in  the  last  month  much  more  frequent  than  even  in  the 
first  or  second.     Tardieu  also  came  to  a  similar  conclu- 
sion.    He  ascertained  that  of  34  cases  investigated  by 
himself,  25  were  in  from  the  third  to  the  sixth  month, 
mostly  in  the  third ;  5  in  the  first  two  months ;  4  in 
the  second  and  eighth  ;  or  that  the  cases  in  the  third 
month,  or  shortly  after,  were  five  times  as  numerous  as 
at  either  an  earlier  or  a  later  period,  and  nearly  three 
times  as  numerous  as  in  both  combined.     Upon  exam- 
ining the  register  of  the  Morgue,  we  find  its  statistics 
strikingly  corroborative  of  this  deduction.     We  have 
already  seen  that  from  1837  to  1854  there  had  been 


28  HALE    ON    ABORTION. 

deposited  at  the  Morgue  692  fcetuses  of  less  than  nine 
months.     Of  these 

23  were  from  the  first  to  the  second  month ; 

79  "  second  "  third  " 

108  "  third     "  fourth  " 

158  "  fourth  "  fifth  " 

150  "  fifth      "  sixth  « 

97  "  sixth   '"  seventh  " 

48  "  seventh"  eighth  " 

29  "  eighth    "     ninth  " 

"  It  has  been  stated  that  519,  or  five-sixths  of  them 
all,  were  not  over  six  months ;  and  it  now  appears  that 
on  a  scale  twenty  times  larger  than  that  given  by  Tar- 
dieu  from  his  own  experience,  nearly  two-thirds  of  the 
foetal  deaths  induced  by  abortion  were  in  from  the  third 
to  the  sixth  month  of  pregnancy,  the  three  periods 
included  giving  a  much  larger  proportion  than  any 
others,  and  the  last  two  of  them  being  nearly  identical. 
The  extreme  paucity  shown  by  the  above  table  in  the 
first  and  ninth  months,  and  the  decrease  in  the  seventh 
and  eighth  from  those  preceding,  are  worthy  of  remark. 
It  is  probable  that  the  sudden  increase  may  be  attribut- 
able to  mental  reaction  after  the  first  shock  occasioned 
by  the  absolute  certainty  of  pregnancy,  is  past ;  and 
the  subsequent  decrease  to  the  fact  that  in  many  at- 
tempted criminal  abortions,  during  the  latter  months, 
children  are  born  alive,  the  mother's  courage  then  prov- 
ing insufficient  for  infanticide,  and  its  greater  and  more 
probable  punishment." 

My  observation  has  shown  me  that  criminal  abortions 
are  very  frequent  in  the  fourth  week  after  conception. 
Many  women,  who  are  habitually  regular  to  a  day,  are 
in  the  habit  of  using  some  drug  or  instrument  if  the 
menses  delay  a  few  days,  and  they  have  reason  to  sup- 
pose conception  has  taken  place.  They  allege  that  they 


STATISTICS    OF    ABORTION.  29 

know  by  certain  sensations  that  conception  lias  occurred, 
as  early  as  the  third  or  fourth  week.  This  habit  is 
more  frequent  than  has  been  supposed,  as  any  physician 
will  ascertain  who  seeks  to  investigate  the  matter. 

In  order  to  make  complete  the  statistics  of  abortion, 
we  should  be  able  to  present  tables  representing  the 
average  mortality  of  women  who  suffer  that  accident, 
both  from  criminal  and  other  causes.  "  The  results  of 
abortion  from  natural  causes,"  says  Dr.  Store r,  "  as 
obstetric  disease,  separate  or  in  common,  of  mother, 
foetus  or  membranes,  or  from  a  morbid  habit  consequent 
on  its  repetition,  are  much  more  than  those  following 
the  average  of  labors  at  the  full  period.  If  the  abortion 
be  from  accident,  from  external  violence,  mental  shock, 
*  great  constitutional  disturbance  from  disease  or  poison, 
or  even  necessarily  induced  by  the  skillful  physician  in 
early  pregnancy,  the  risks  are  worse.  But  if,  taking 
into  account  the  patient's  constitution,  her  previous 
health,  and  the  period  of  gestation,  the  abortion  had 
been  criminal,  then  the  risks  are  infinitely  increased." 
In  34  cases  of  criminal  abortion  reported  by  Tardieu, 
where  the  history  was  known,  22  were  followed  as  a 
consequence  by  death,  and  only  12  were  not.  In  15 
cases*  necessarily  induced  by  physicians,  not  one  was 
fatal. 

These  meagre  statistics  are  all  I  have  been  able  to 
obtain  relative  to  the  consequences  of  abortion,  to  the 
mother.  While  I  admit  that  the  risks  of  a  fatal  result  from 
criminal  abortion  brought  about  by  other  than  skillful 
physicians,  or  even  from  diseased  condition,  are  great,  I 
cannot  believe  the  result  of  abortion  "  necessarily  in- 
duced by  skillful  physicians,"  is  as  fatal  as  Dr.  Storer 

*   Annals  de  Hygiene,   185(5,  p.  147. 


30  HALE    ON    ABORTION. 

asserts.  My  observation  and  experience  in  this  matter 
have  been  quite  extensive,  and  I  have  been  led  to  the 
conclusion  that,  if  the  operation  is  skillfully  performed, 
the  fatal  results  need  not  exceed  one  in  a  thousand. 

I  have  not  been  able  to  find  any  statistics  relative*  to 
the  proportionate  frequency  of  the  various  diseased  con- 
ditions which  result  from  abortion  ;  but  the  information 
which  I  have  received  from  my  colleagues,  and  the 
various  writers  on  diseases  of  women,  as  well  as  my  own 
observations,  lead  me  to  place  the  consequences  of  abor- 
tion and  their  relative  frequency  in  the  following  order : 

1.  Ulceration,  erosion  and  congestion  of  the  os  uteri. 

2.  Premature  and  profuse  menses. 

3.  Retroflexion  and  retroversion  of  the  uterus. 

4.  Prolapsus  uteri. 

5.  Ovarian  disease.  • 

6.  Pelvic  cellulitis. 

The  statistics  relating  to  the  causes  of  abortion,  as 
well  as  those  having  reference  to  the  various  other 
matters  connected  with  the  subject,  will  be  found  under 
the  appropriate  chapters. 


PART    II. 

CAUSES  OF  ABORTION. 


CAUSES  OF  ABORTION. 

The  following  Classification  of  the  causes  of  Abortion 
is  based  upon  the  one  used  by  Prof.  Ludlam  in  his 
Lecture  before  the  class  of  Hahnemann  Medical  Col- 
lege. The  additions  made  by  myself  will  be  denoted 
by  the  initial  H. 

/.    Constitutional  or  Predisponent. 

1.  Plethora. 

2.  Anaemia  or  Chlorosis. 

3.  The  Scrofulous  Diathesis. 

4.  Return  of  Menstrual  Crisis. 

(a)  Syphilis. 

(b}  Mercurialization. 


r  Zymotic 

O.      TV   • 


Diseases. 


(c)  Variola. 

(d)  Scarlatina. 

(e)  Diphtheria. 
(/)  Cholera,     (H.) 


II.   Local  or  Organic. 

1.  Malformation  of  ovum. 

2.  of  membrane. 

(a)  Mai-location  of     (Placenta  Previa.) 
Organic  Disease  of 


3. 


Placental 
Abnormalities. 


(c)  Detachment  of 

(d)  Fatty  Degeneration  of 

(e)  Calcareous       "         of 
(/)  Hydatids.     (H.) 

(g)  Moles.     (H.) 

III.    Reflex  (Exciting.] 

(a)  Emotional — as  Fright,  Anger,  Grief,  etc. 

(b)  Direct  blows  upon  the  brain  or  spinal  cord. 
(c}  Medicinal.     (H.) 

(d)  Cerebro  Spinal  Meningitis. 

3 


84 


HALE    ON    ABORTION. 


2.    Concentric.  < 


(a)  Parotidean     Irritation.     (H.) 
(6)  Thyroideal  "  (H.) 

(ft  Thoracic  "  (H.) 

(d)  Mammary  " 

(e)  Dental  "  (H.) 
(/)  Gastric                  " 

(g)  Rectal  " 

(h)  Vesical  "       also  Renal.   (H.) 

(f)  Vaginal  "  (H.) 
(j)  Hysterical             " 

(k)  Epilepsy. 

(I)    Falls,  jumping,  blows,  etc. 

(m)  Functional  and  Organic  Diseases  of  the 

Uterus.     (H.) 
(n)  Functional  and  Organic  Diseases  of  the 

Ovaries.     (H.) 

(o)  Displacements  of  the  Ovaries. 
(p)  Death  of  Embryo. 
(q)  Genital     (Coitus.) 
(r)       "          (Instrumental.) 


MEDICINAL. 
Emmenagogues  or  Oxytoxics. 

The  following  list  of  medicinal  agents  is  necessarily 
imperfect,  but  I  have  placed  therein  the  drugs  which 
may,  under  certain  circumstances,  cause  abortion.  The 
list  is  not  complete,  as  there  are  many  medicines  not 
named  which  have  been  supposed  to  cause  that  accident. 


Apis  mellifica. 

Actsea  alba. 

Aloes. 

Asarum  europeum. 

"      canadense. 
Asclepias  syriaca. 

"       incarnata. 
Aletris  farinosa. 
Baptisia  tinctoria. 


Borax. 

Bovista. 

Cantharis. 

Caulophyllum. 

Cimicifuga. 

Decodon  verticillatus. 

Gossipium  herbaceum. 

Ilex  opaca. 

Mercurius. 


Podophyllum. 

Quinise  sulphas. 

Ruta  graveolens 

Sabina. 

Secale  Cornutum. 

Sanguinaria. 

Terebinth. 

Tanacetum  vulgaris. 

Ustilago  madis. 


SECTION  I. 


PEEDISPOSING    CAUSES. 

Plethora. 

The  first  predisposing  cause  of  Abortion  mentioned 
in  the  foregoing  table  is  Pletliwa ;  but  it  is  oftener  a 
cause  of  sterility,  and  will  be  again  alluded  to  under 
that  head.  Obesity  may  cause  abortion  in  several  ways. 
The  deposition  of  fat  in  the  abdomen  and  pelvis  will 
have  the  same  effect  as  a  tumor  in  those  localities.  In 
some  cases  of  adiposis  the  action  of  the  heart  is  mani- 
festly impeded,  and  sometimes  entirely  arrested,  by  the 
deposition  of  fat  in  and  around  it.  The  same  result 
may  obtain  in  regard  to  the  uterus,  and  prevent  its 
expansion  beyond  a  certain  point,  at  which  abortion 
would  inevitably  occur.  Dr.  Gardner  also  suggests 
that  the  .deposit  may  "  press  down  the  uterus,  pressing 
it  into  the  pelvic  strait,  sometimes  producing  eversiou, 
or  so  that  the  os  uteri  presses  upon  the  sacrum,  where 
by  mere  friction  its  surface  becomes  abraded,  and  pro- 
fuse leucorrhoea  ensues."  Not  only  this,  but  prolapsus 
and  retroversion  may  be  thus  caused. 

Ancemia  or  Chlorosis. 

Frequent  abortions  may  cause  anaemia;  and  this 
condition  may  in  turn  predispose  to  repeated  abortions, 


36  HALE    ON   ABORTION. 

the  uterus  not  having  sufficient  "tone,"  or  vitality,  to 
retain  the  product  of  conception.  Chlorotic  women  are 
as  liable  to  abortion  as  those  who  are  anaemic,  and  from 
the  same  cause,  namely — a  lack  of  vitality  in  the  uterus, 
and  a  blood  so  impoverished  that  it  is  incapable  of 
nourishing  the  foatus. 

Scrofula. 

4 

The  scrofulous  diathesis,  by  its  influence  upon  the 
vital  powers  of  the  system,  causing  laxity  of  tissue,  defi- 
cient nervous  force,  and  depriving  the  blood  of  its  nor- 
mal constituents,  is  a  powerful  predisponent  cause  of 
loss  of  the  ovum  at  any  and  all  periods  of  gestation. 

Return  of  the  Menstrual  Crisis. 

This,  as  a  cause  of  abortion,  especially  in  the  first 
months,  has  not  been  sufficiently  appreciated.  I  have 
stated  in  the  introduction  to  this  work,  that  I  consider 
it  proper  to  define  "Abortion,"  as  the  premature  death 
and  expulsion  of  the  ovum  at  any  time  after  conception, 
or  before  the  ejid  of  the  ninth  month.  I  have  also 
mentioned,  in  another  place,  the  frequency,  of  abortions 
in  the  first  month. 

The  older  accouchers  paid  much  attention  to  the  loss 
of  the  ovum  shortly  after  impregnation.  Married 
women  who  passed  over  a  monthly  period  by  a  few 
days  and  then  menstruated  profusely  were  believed  to 
have  lost  the  ovum.  This  was  called  an  effluxion,  if  it 
occurred  before  the  tenth  day,  "  because,"  as  Smollie 
observes,  "the  embryo  and  secundines  are  not  yet 
formed,  and  nothing  but  the  liquid  conception,  or  geni- 
tura,  is  dislodged.  Tyler  Smith  thinks  such  cases  are 
not  uncommon,  and  the  ovum  is  unobserved,  not  from 


CAUSES    OF   ABORTION.  3V 

its  liquid  condition,  but  because  it  is  so  little  above  the 
size  of  the  unimpregnated  ovum,  as  not  to  be  visible  in 
the  discharges.  An  ovum  of  fourteen  days  has  been 
described  by  Velpeau,  and  its  size  did  not  exceed  three- 
eighths  of  an  inch  in  diameter.  In  the  expulsion  of  an 
ovum  of  an  earlier  date  than  this,  the  symptoms  hardly 
differ  from  those  of  profuse  menstruation.  In  cases  of 
dysmenorrho3a — especially  the  pseudo-membranous  va- 
riety, and  in  cases  of  profuse  menstruation  (habitual) — 
this  loss  of  the  ovum  may  frequently  occur  at  a  very 
early  period.  It  has  often  'been  a  matter  of  wonder  to 
me  that  the  uterus  should  so  frequently  resist  the  influ- 
ence of  a  menstrual  nisus,  when  abnormal  in  its  charac- 
ter, or  that  a  diseased  uterus  could  so  often  bear  the 
recurrence  of  the  crisis  when  normal,  without  being 
irritated  to  such  an  extent  as  to  throw  off  the  impreg- 
nated ovum  at  such  periods.  (See  Ovarian  Irritation.) 

ZYMOTIC    DISEASES. 

Syphilis. 

Independent  of  the  power  which  this  blood-poison 
possesses  of  causing  diseases  of  the.  uterus — as  ulcera- 
tion,  etc.,  which  will  be  mentioned  in  another  place- 
syphilis  seems  to  exercise  a  blighting  power  over  the 
product  of  conception,  in  such  a  manner  that  it  is  liable 
to  die  in  utero,  of  the  same  poison,  and  be  expelled  as 
a  foreign  body,  at  any  period  of  pregnancy,  or  the 
membranes  may  become  diseased  from  the  pernicious 
influence  of  the  malady :  in  both  cases  the  disease  may 
be  transmitted  by  either  or  both  parents :  by  the 
mother  through  the  circulation,  and  by  •  the  father 
through  the  spermatozoa. 

Writing  of  this  disease,  as  a  cause  of  sterility,  Dr. 


38  HALE    OX    ABORTION. 

Gardner  says :  "  In  my  opinion  it  is  more  often  a  cause 
of  early  abortion  from  an  imperfect  development  of  the 
ovum,  than  a  cause  of  sterility,  as  it  is  difficult  to  decide 
whether  the  woman  was  ever  impregnated  or  not.  The 
menses  are  retained  a  few  days  over  the  usual  period ; 
there  is  finally  a  somewhat  profuse  discharge,  accom- 
panied by  more  pain  than  usual,  and  the  passage  of 
what  are  considered  clots,  but  in  them  lies  concealed 
the  semi-developed  ovum." 

Mercurihlization. 

Mercury,  in  its  various  forms,  may  not  only  be  an 
immediate  cause  of  abortion,  as  in  the  cases  of  large 
doses  of  calomel,  elsewhere  alluded  to,  but  the  system 
inay.be  so  saturated  with  the  poison  that  the  blood  and 
tissues  are  deprived,  by  its  baleful  influence,  of  the 
normal  vitality  necessary  to  carry  on  the  process  of 
gestation.  The  effects  of  this  drug  upon  the  organism 
are  not  unlike  those  of  syphilis.  It  has  long  been  re- 
marked that  women  whose  systems  have  been  saturated 
with  mercurial  preparations  were  very  liable  to  abor- 
tions, and  this  without  any  organic  disease  being  dis- 
covered in  the  organs  of  generation. 

Variola,  etc. 

Abortion  may  occur  from  the  intense  febrile  orgasm, 
or  from  the  congestive  complications  which  take  place 
during  these  disorders.  All  the  exantliematous  fevers 
predispose  the  system  to  take  on  such  irritative  con- 
ditions as  may  bring  about  miscarriage  during  or  after 
their  accession.  The  foetus  in  utero  has  been  known 
to  be  attacked  with  the  variola,  and  be  expelled  either 
before  or  after  its  death. 


CAUSES    OF    ABORTION.  39 

According  to  Cazeaux,  "  confluent  small-pox  nearly 
always  occasions  abortion,  and  this  is  almost  uniformly 
followed  by  the  death  of  the  mother." 

Asiatic  Cholera  and  Yellow  Fever 

are  powerful  zymotic  poisons,  and,  like  other  diseases 
of  this  character,  effect  the  foetus  through  the  medium 
of  the  circulation. 

Dr.  Pulte*  states  that  during  the  cholera  epidemic  of 
1848  abortions  were  very  frequent,  and  were  apparently 
caused  by  the  imponderable  poison  pervading  the  at- 
mosphere at  that  time.  The  same  phenomena  has  been 
noticed  during  the  prevalence  of  yellow  fever  in  the 
large  cities  of  the  South. 

Dr.  Bouchut,  in  a  quite  recent  work,  mentions  his 
observation  of  fifty-two  cases  of  cholera  in  pregnant 
women,  twenty-five  of  whom  aborted  in  consequence  of 
the  disease. 


SECTION    II. 

LOCAL    CAUSES. 

Abnormal  conditions  of  the  Ovum  and  its  Appendages. 

Dr.  Whitehead  says  these  are  "  so  constantly  associ- 
ated with  disease  of  the  maternal  organs  as  to  lead  to 
the  suspicion  that  the  mischief,  in  a  great  majority  if 
not  in  all  instances,  originates  in  the  latter."  In  my 
own  practice,  such  complication  has  been  almost  invari- 
ably found  in  those  cases  wherein  I  have  had  an  oppor- 
tunity of  making  the  necessary  examination. 

*  Homoeopathic  Domestic  Physician,  477. 


40  HALE    ON    ABORTION. 

The  fcetus  is  liable  to  many  diseases  winch  may  tend 
to  its  death,  such  as  inflammation  and  dropsy  of  its 
venous  cavities,  dropsy  of  anmion,  disease  of  the  liver 
or  kidneys,  tubercular  diseases,  syphilis,  and  even  small 
pox ;  diseases  of  the  umbilical  cord,  knots  upon  the 
cord ;  strangulation,  by  the  twisting  of  the  cord  about 
the  neck  of  the  child.  I  have  seen  cases  in  which  the 
cord  was  twisted  three  and  four  times  around  the  neck. 
Probably  the  diseased  ovum  excites  the  uterus  to  con- 
traction before  the  actual  death  of  the  ovum  has 
occurred. 

In  many  cases  of  criminal  abortion  the  injury  done 
to  the  child  by  instruments,  etc.,  is  the  real  cause  of 
the  abortion.  The  membranes  may  not  be  ruptured  or 
separated. 

The  impregnated  ova  may  degenerate  into  moles, 
hydatids,  or  " bligMed ova" 

Genuine  moles  are  to  be  distinguished  from  certain 

O 

fibrinous  masses  which  are  sometimes  expelled  from  the 
uterus.  These  are  called  spurious  moles,  and  a  close 
examination  will  show  their  real  character.  Those 
moles  which  are  the  result  of  impregnation  are  of  vari- 
ous kinds,  consisting  of  different  forms  of  degeneration 
of  the  membranes  of  the  ovum.  We  can  readily  dis- 
tinguish the  varieties  of  moles  depending  on  the  carne- 
ous  or  fleshy,  the  hydatigenous,  and  the  fatty,  and 
other  degenerations  of  the  membranes.  None  of  these 
cases  can  occur  without  conception.  Many  authors 
believed  that  fleshy  moles  might  occur  in  nuns,  and 
others  presumed  to  be  virgins,  without  the  occurrence 
of  intercourse.  Percy  believed  that  hydatids  were  in- 
dependent animals,  and  that  their  production  was  com- 
patible with  the  purest  chastity.  Dennison  thought 
they  sometimes  originated  in  the  uterus  as  independent 


CAUSES    OF   ABORTION.  41 

formations,  and  Sir  Charles  Clarke  was  pf  opinion  that 
uterine  hydatids  might  exist  apart  from  pregnancy. 
Madam  Boivin  and  several  other  writers  are  in  favor 
of  the  belief  that  this  form  of  degenerated  ovum  may 
be  retained  for  many  months,  or  even  years,  after  the 
ordinary  date  of  labor.  Tyler  Smith  is  not  aware  that 
any  case  of  this  kind  has  been  observed.  I  have  known 
two  cases  in  my  own  practice  where  a  hydatid  mass  was 
not  expelled  until  the  twelfth  month  after  the  last 
appearance  of  the  menses.  Those  who  wish  to  investi- 
gate the  nature  of  moles  and  hydatids  can  consult  Tyler 
Smith* 

In  the  carneous  moles  there  is  an  arrest  of  the  usual 
symptoms  of  pregnancy,  and  the  patient  remains  out  of 
health.  The  ovum  from  the  time  of  its  death  becomes 
to  a  great  extent  a  foreign  body,  and  is  a  source  of 
irritation  to  the  system  generally.  No  increase  of  size 
takes  place,  so  that  at  the  fourth  or  fifth  month  the 
uterus  may  not  be  larger  than  it  should  be  in  the  fifth 
or  sixth  week  of  normal  pregnancy.  The  complexion 
is  muddy  and  the  breath  fetid,  with  loss  of  appetite  and 
digestion.  Hemorrhage  frequently  occurs,  but  not  very 
profuse. 

The  hydatid  mole  causes  symptoms  more  strongly 
marked.  The  increase  in  size  is  often  enormously  rapid, 
so  that  at  the  fifth  or  sixth  month  the  abdomen  is  as 
it  should  be  at  the  end  of  pregnancy.  The  shape  of  the 
uterus  is  often  quite  different  from  that  existing  during 
natural  pregnancy.  There  is  absence  of  all  foetal  move- 
ments and  the  sounds  of  the  fcetal  heart.  After  three 
or  four  months'  suspension  of  the  catamenia,  there  oc- 
curs a  copious  discharge  of  water  and  blood,  resembling 

*  Lectures  on  Obstetrics. 


42  HALE    ON    ABORTION. 

red  currant  juic£.  This  occurs  irregularly  and  in  vari- 
able quantities.  The  watery  discharge  is  accompanied 
by  pain,  and  appears  to  be  caused  by  the  breaking 
down  of  numbers  of  the  larger  hydatids.  In  a  suspected 
case  the  discharges  should  be  carefully  examined,  and 
of  course  the  detection  of  a  single  hydatid  renders  the 
diagnosis  certain.  Excessive  flooding  often  occurs,  at 
frequent  intervals,  accompanied  with  discharges  of 
masses  of  hydatids.  The  general  health  suffers  pro- 
foundly, resulting  in  anaemia,  dropsy,  and  even  paral- 
ysis. 

Fatty  Deterioration  of  the  Chorion  and  Placenta. 

We  are  indebted  to  Dr.  Kobert  Barnes  for  our  know- 
ledge of  this  frequent  cause  of  abortion.  This  form  of 
degeneration  may  affect  the  secundines  at  any  time 
between  the  early  weeks  of  pregnancy  and  the  termina- 
tion of  gestation.  Fatty  degeneration  may  exist  in  the 
placenta  as  a  post  mortem  change ;  that  is,  it  may  occur 
in  utero  after  the  death  of «the  foetus.  It  may  happen 
also  as  the  result  of  the  transformation  of  effused  fibrin 
in  inflammatory  disease  of  the  placenta,  or  of  a  clot  of 
blood  in  hemorrhagic  effusion.  Lastly,  it  may  consist 
of  the  metamorphosis  of  portions  of  the  maternal  and 
foatal  structures  of  the  placenta  during  the  life  of  the 
foetus.  The  latter  pathological  phenomenon  is  that 
which  is  of  the  chiefest  importance  in  relation  to  abor- 
tion. 

In  a  placenta  affected  with  fatty  degeneration,  the 
lobes  of  the  placenta  are  altered  in  appearance,  some  of 
them  being  of  yellow  fatty  color,  brittle  and  exsanguine, 
the  rest  presenting  their  ordinary  characters.  Exam- 
ined more  minutely,  the  tufts  are  found  to  be  glistening, 
hard  and  tallowy,  and  not  expanding  when  placed 


CAUSES    OF   ABORTION.  43 

under  water,  as  is  the  case  with  villi  of  healthy  pla- 
centae. The  microscopical  investigations  of  Dr.  Hassall, 
show  that  the  villi  are  studded  with  spherules  and  drop- 
lets of  fatty  matter  and  oil.  The  fatty  material  is  found 
principally  in  the  cells  of  the  villi,  and  in  the  coats  of 
its  blood  vessels,  which  vessels  do  not  carry  red  globules 
when  the  degeneration  exists  to  any  extent.  Dr.  Barnes 
considers  constitutional  syphilis  a  frequent  cause  of  this 
disease.  Fatty  degeneration  causes  abortion  by  destroy- 
ing the  vitality  of  the  ovum ;  or  owing  to  the  friable 
condition  of  the  placenta,  partial  separation  may  occur ; 
or  the  partially  degenerated  blood  vessels  may  burst 
and  lead  to  placental  apoplexy.  For  a  full  description 
of  this  disease  of  the  placenta  and  chorion,  see  Tyler 
Smith's  Lectures  on  Obstetrics,  page  185. 

Congestion  of  the  Placenta 

Leads  to  what  is  termed  apoplectic  effusion.  Blood 
may  be  poured  out  either  on  the  foetal  or  external  sur- 
face of  the  placenta.  It  may  produce  abortion  in  sev- 
eral ways.  The  loss  of  blood  may  deprive  the  foetus 
of  life  ;  or  the  effusion  may  excite  the  separation  of  the 
ovum,  and  cause  uterine  contractions.  In  some  cases 
the  effused  blood  coagulates,  its  fluid  portions  are  re- 
moved, and  a  fibrous  mass  remains  without  doing  any 
great  injury. 

Inflammation  of  the  Placenta  (Placentitis) . 

In  this  disease  effusion  of  lymph  may  occur,  or  the 
disease  may  pass  on  to  hepatization,  suppuration,  or 
gangrene.  Sometimes,- when  the  inflammation  affects 
the  internal  surface  of  the  placenta,  adhesions  form 
between  the  placenta  and  the  external  surface  of  the 


44  HALE    ON    ABORTION. 

ovum.  In  this  way  the  placenta  lias  been  found  adher- 
ent to  the  forehead  or  body  of  the  foetus.  According 
to  Professor  Simpson,  who  wrote  an  elaborate  memoir 
on  this  subject,  the  symptoms  are  obscure,  consisting  of 
pain  in  the  uterus,  near  the  site  of  the  placenta,  pains 
in  the  back  and  thighs,  and  general  fever.  Tyler 
Smith  did  not  find,  on  stethoscopic  examination,  any 
modification  of  the  uterine  sounds  in  cases  of  suspected 
placentitis.  The  causes  of  placentitis  are  not  very 
obvious,  beyond  mechanical  injuries,  and  the  great 
afflux  of  blood  to  the  organ  which  occurs  during  preg- 
nancy. Congestion  and  inflammation  of  the  placenta 
are  probably  both  common  causes  of  abortion. 

The  placenta  is  liable  to  other  diseases,  as  calcareous 
degeneration,  tubercular  deposits,  and  atrophy  or  hyper- 
trophy. Sometimes,  after  the  death  of  the  foatus,  the 
placenta  is  still  nourished,  imperfectly,  but  still  suffi- 
ciently to  insure  its  retention,  together  with  the  dead 
ovum,  for  a  considerable  time. 

Placenta  Previa 

May  be  the  cause  of  abortion  at  any  period  of  preg- 
nancy. Of  378  cases  mentioned  by  Whitehead,  eight 
were  from  this  cause.  When  the  placenta  is  implanted 
on  the  os  uteri,  abortion  is  inevitable,  and  this  almost 
invariably  takes  place  before  the  fifth  month.  When 
only  a  small  portion  of  it  extends  over  the  orifice,  ges- 
tation may  proceed  to  the  seventh  or  eighth  month,  or 
even  to  the  full  period,  without  producing  any  great 
amount  of  danger  to  the  process ;  but  always,  under 
such  circumstances,  separation  takes  place  to  some  ex- 
tent as  the  cervix  expands,  although  premature  expul- 


CAUSES    OF    ABORTION.  45 

sion  is  not  an  inevitable  consequence.  Whitehead 
mentions  a  case  of  implantation  of  placenta  on  the  os 
uteri,  and  its  partial  separation,  attended  with  hemorr- 
hage before  quickening,  which  he  treated  with  favor- ' 
able  results. 


SECTION    III. 

REFLEX    CAUSES. 

The  centmc  causes  of  abortion  are  those  which  origi- 
nate in  the  nervous  centres,  the  brain  or  spinal  cord, 
and  act  upon  the  uterus  in  a  direct  manner.  They  may 
be  divided  into  Emotional,  Physical,  and  Medicinal. 

Emotional. — Fright,  anger,  joy,  grief,  and  other  men- 
tal influences,  have  been  known  to  cause  such  disturb- 
ance in  the  organism,  as  to  be  a  direct  cause  of  the 
expulsion  of  the  foetus.  Many  cases  are  on  record 
where  the  death  of  the  foetus  has  resulted  from  the  per- 
turbing effects  of  emotional  shocks.  Women  have 
aborted  immediately  after  hearing  of  the  death  of  a 
beloved  husband;  or  the  gnawing  canker  of  grief, 
shame,  and  remorse,  has  led  to  loss  of  the  foetus ;  and 
martyred  women  have  aborted  at  the  stake. 

Physical. — Under  this  head  we  may  enumerate  direct 
blows  upon  the  brain,  or  spinal  cord,  or  intense  conges- 
tion or  paralysis  of  those  organs.  Some  interesting 
experiments  have  been  made,  which  have  a  bearing 
upon  the  centric  causes  of  abortion.  M.  Serres  divided 
the  spinal  cord  in  animals,  after  the  commencement  of 
parturition,  and  the  process  was  arrested.  In  other  ex- 


46  HALE    ON    ABORTION. 

periments  he  excited  abortion  in  animals  by  irritating 
the  spinal  marrow  in  the  lumbar  region.  M.  Brachet 
divided  the  cord  in  guinea  pigs,  between  the  twelfth 
and  thirteenth  dorsal  vertebra,  after  the  commencement 
of  labor,  and  everything  but  feeble  contractions  of  the 
uterus  was  arrested,  the  animals  dying  in  a  few  days 
undelivered.  M.  Segales  made  a  section  of  the  cord 
high  up,  without  influencing  the  uterus,  but  the  organ 
was  paralyzed  when  the  division  was  practiced  low 
down.  Cases  are  detailed  by  the  above  authors  as  oc- 
curring in  the  human  subject,  in  which,  in  paralysis 
depending  upon  disease  high  up  in  the  spinal  marrow, 
uterine  action  was  not  interfered  with ;  but  was  dimin- 
ished or  suspended  altogether  in  cases  of  paraplegia — 
the  result  of  injury  or  disease,  low  down  in  the  cord. 
Dr.  Simpson  has  lately  made  some  experiments  which 
go  to  negative  the  above.  In  his  experiments,  parturi- 
tion is  said  to  have  occurred,  notwithstanding  the  des- 
truction of  the  lower  portion  of  the  spinal  marrow.  If 
such  are  Dr.  Simpson's  results,  they  will  not  prove  the 
independence  of  the  uterus  of  reflex  action,  since,  from 
the  connections  of  the  greater  and  lesser  splanchic 
nerves  and  the  thoracic,  abdominal  and  pelvic  plexuses 
and  ganglia,  it  is  quite  possible  that  the  uterus  may 
receive  spinal  fibres  from  the  upper  portion  of  the 
spinal  marrow.  The  latter  conditions  may  be  caused 
by  disease  (idiopathic)  or  influences  which  we  may 
term 

Medicinal.  —  Certain  medicines*  undoubtedly  cause 
abortion  by  their  direct  effect  upon  the  brain  or  spinal 
cord.  Those  which  produce  congestive  conditions  are 
Quinine,  Sti'ychnine,  and  Ergot. 

Quinine,  according  to  Dr.  Gardner,  and  several  other 
observers,  has  been  known  to  cause  abortion,  and  they 


CAUSES    OF   ABOKTION.  47 

caution  the  practitioner  against  its  use  during  preg- 
nancy. The  specific  action  of  this  drug  upon  the 
nervous  centres  is  admitted  by  nearly  all  toxicologists. 
Dr.  Brown-Seojuard  says  it  causes  engorgement  of  the 
vessels  of  the  brain  and  spinal  cord.  While  engaged 
in  an  extensive  practice,  in  a  locality  noted  for  malari- 
ous diseases,  I  found  that  abortions  were  frequent 
among  the  patients  of  my  allopathic  colleagues,  who 
gave  quinine  in  massive  doses  (5,  10,  or  15  grains). 
The  accident  was  supposed  to  be  induced  by  the  dis- 
eases for  which  it  was  administered.  No  such  results 
occurred  in  my  practice,  although  the  cases  under  my 
care  were  as  severe  as  any  under  allopathic  treatment. 
Only  a  small  portion  of  my  patients  were  treated  with 
quinine,  and  those  to  whom  I  was  obliged  to  prescribe 
it  took  it  in  small  doses,  not  exceeding  one  grain  every 
two  or  three  hours.  I  am  fully  satisfied  that  the  mis- 
carriages alluded  to  are  caused'  by  the  quinine,  and  not 
by  the  chill  or  febrile  paroxysm. 

Strychnine  has  caused  abortion.  The  tetanic  spasms 
which  occur  in  cases  of  poisoning  by  this  drug  seem 
detrimental  to  the  life  of  the  foetus  or  the  integrity  of 
the  uterine  tissues.  It  causes  congestion  of  the  spinal 
cord  and  its  membranes.  The  foetus  may  not  be  ex- 
pelled while  the  woman  is  under  the  influence  of  the 
poison,  for  in  a  frog,  rendered  tetanic  by  strychnia,  the 
ova  was  not  expelled  during  the  tetanoid  symptoms, 
but  some  days  afterward,  when  the  spasms  had  nearly 
disappeared. 

Ergot. — This  agent  has  been  supposed  by  some  to 
act  upon  the  uterus  through  the  cord.  Tyler  Smith 
says :  "  The  ergot  of  rye  passes  into  the  blood,  and 
affects  the  spinal  centre,  being  specially  directed  to  the 
lower  part  of  the  spinal  marrow,  and  to  that  part  of  it 


48  HALE   ON    ABORTION. 

in  relation  to  the  uterus."  Others  contend  that  it  acts 
through  the  circulation  directly  upon  the  uterine  tissues. 
Brown-Sequard,  however,  classes  it  among  the  medi- 
cines which  cause  congestion  of  the  vessels  of  the 
spinal  cord. 

Carbonic  acid,  savin,  aloes,  alcohol,  biborate  of  soda, 
and  ipecacuanha,  are  supposed  by  Tyler  Smith*  and 
some  others  to  act  in  a  similar  manner.  This  can,  how- 
ever, hardly  be  said  of  all  the  above  agents.  Ipecac 
acts  upon  the  gastric  nerves ;  carbonic  acid.,  alcohol, 
and  perhaps  borax,  may  act  through  the  cord,  but 
aloes  and  savin  appear  to  me  to  act  in  quite  a  different 
manner.  The  former  seem  to  act  by  irritating  the 
rectum,  the  latter  as  an  irritant  to  the  uterus  through 
the  medium  of  the  blood,  and  rank  with  tanacetum, 
turpentine,  uva  ursi,  cantharis,  etc.  If  these  medicines, 
however,  are  given  in  massive  doses,  they  may  act 
through  both  media. 

There  are  other  medicinal  agents  which  may  act  as 
centric  causes  of  abortion,  namely,  gelseminum,  caulo- 
phyllam,  cimicifuga,  cannabis  indica,  and,  perhaps, 
gossipium.  Gelsemijvum  probably  causes  abortion  by 
paralyzing  the  lower  portion  of  the  spinal  cord.  When 
given  in  large  quantities  during  parturition,  it  arrests 
that  process.  In  small  doses  it  facilitates  labor,  and 
increases  the  contractions  of  the  uterus.  The  other 
remedies  mentioned  probably  cause  miscarriage  by 
irritating  the  whole  or  a  portion  of  the  cord. 

GALVANISM:  may  be  applied  so  as  to  act  as  a  centric 
cause  of  abortion. 

The  state  of  the  circulation  affects  the  spinal  centre 
in  a  very  distinct  manner.  Want  or  excess  of  blood,  or 
materies  morbi  in  the  circulation,  act  as  a  direct 

*  Lectures  on  Obstetrics,  p.  264. 


CAUSES    OF   ABORTION.  49 

stimuli  to  the  spinal  centre,  and  in  this  way  may  induce 
abortion  or  premature  labor.  Certain  diseases  may  act 
as  predisponents,  or  exciting  causes  of  abortion,  by  the 
influence  which  they  exert  directly  upon  the  spinal 
centre.  Among  these  diseases  may  be  mentioned, 
cerebro-spinal-meningitis,  myelitis,  diphtheria,  scarla- 
tina, etc.,  examples  of  which  will  be  mentioned  in 
their  appropriate  places. 

CEREBRO  SPINAL-MENINGITIS,  OR  SPOTTED  FEVER.  I 
find,  on  examining  the  reported  cases  of  this  disease, 
that  it  almost  invariably  causes  abortion  in  those  preg- 
nant women  who  are  its  victims.  This  is  what  we  might 
expect  from  a  malady  which  strikes  with  fearful  force 
the  great  nerve  centres. 

Dr.  Black*  reports  a  case  of  a  woman  aged  thirty-one, 
mother  of  five  children,  and  in  the  fourth  month  of  her 
sixth  pregnancy,  of  good  constitution,  who  was  taken 
with  a  prolonged  chill,  severe  aching  over  the  whole  body, 
and  parturient  pains.  On  the  afternoon  of  the  same 
day  had  second  chill,  not  so  severe  as  first,  succeeded 
by  very  high  fever,  and  an  increase  of  pains.  During 
the  niglit  sJie  aborted.  The  fcetus  appeared  natural,  the 
secundines  passing,  without  difficulty  or  haemorrhage.'1'1 
This  woman  succumbed  to  the  allopathic  treatment  on 
the  tenth  day. 

Several  cases  have  come  under  my  observation,  and 
to  my  knowledge,  where  this  disease  caused  abortion. 
One  peculiarity  marks  all  the  cases,  namely,  the  abor- 
tion occurs  shortly  after  the  onset  of  the  attack.  I 
have  been  struck  with  the  close  similarity  between  the 
chill  (rigor)  and  general  symptoms  of  pain,  prostration, 

*  American  Journal  of  Medical  Science,  No.  98,  p.  345, 
4 


50  HALE   ON   ABORTION. 

etc.,  which  attend  the  onset  of  both  spotted  fever  and 
most  cases  of  abortion. 


SECTION    IV. 

CONCENTRIC    OR   REFLEX-SPINAL    CAUSES    OF   ABORTION. 

It  will  be  well,  before  we  enter  into  the  considera- 
tion of  the  special  concentric  causes  of  abortion,  if  the 
physician  or  student  refreshes  his  memory  concerning 
the  sympathetic  relations  of  the  uterus  with  other  por- 
tions of  the  body,  and  the  manner  in  which  such  rela- 
tions are'  kept  up.  The  uterus  is  in  relation  with  the 
cerebral,  spinal  and  ganglionic  divisions  of  the  nervous 
system,  and  possesses  properties  derived  from  each  of 
these  sources  of  motor  power.  The  uterus  is  withdrawn 
from  the  direct  influence  of  volition.  The  will  has  no 
direct  power  either  to  contract  or  dilate  this  organ. 
Labor  may  take  place  when  cerebral  paralysis  exists— 
the  will  being  entirely  in  abeyance,  or  abolished — as 
when  under  the  influence  of  chloroform,  ether,  or  gelse- 
minitm.  But  though  not  exerting  any  direct  influence, 
volition  may  affect' the  uterus  indirectly.  (The  direct 
influences — as  emotions  of  various  kinds — have  been 
considered.)  The  efforts  at  "  bearing  down"  during  labor 
serve  as  an  illustration  of  indirect  cerebral  influence; 
the  abdominal  muscles  in  this  case  stimulate  the  uterine 
by  pressure.  Since  the  brilliant  discovery  of  the  spinal 
system  by  Dr.  Marshal  Hall,  that  form  of  uterine  action 
depending  upon  the  spinal  marrow  now  admits  of  clear 
comprehension,  and  is  understood  by  all  well-read  phy- 
sicians. 


EXPLANATION  OF  PLATE. — 1.  Posterior  or  sensory  roots  of  spinal  nerves. 
2.  Anterior  or  motor  ditto.  3.  Fallopian  tubes.  4.  Fundus  of  the  uterus. 
6.  Cervix  uteri.  6.  External  os  uteri.  The  arrows  indicate  the  course  of  the 
afferent  and  efferent  currents. 


CAUSES   OF   ABORTION.  53 

The  best  resume  of  the  modus  operandi  of  this  action, 
next  to  that  of  Dr.  Tyler  Smith,*  is  the  clear  elucida- 
tion by  Dr.  K.  Ludlam,f  in  a  valuable  paper  on  the 
"  Reflex  Sympathies  of  the  Uterus."  From  that  paper 
I  quote  the  following  paragraphs,  illustrated  with  the 
diagram  kindly  supplied  to  me  by  the  author : 

"  The  spinal  nervous  filaments  supplied  to  the  uterus 
are  of  two  kinds — the  motor  and  the  sensory,  or  those 
which  arise  from  the  anterior  and  posterior  columns  of 
the  medulla  spinalis.  The  chief  physiological  peculi- 
arity of  these  filaments  is,  that  in  case  of  the  arteries 
and  veins,  their  currents  set  in  different  directions — one 
toward,  and  the  other  out  from,  the  central  organ  of 
the  system.  The  sensory  impression  is  that  of  general 
sensibility,  and  is  afferent  in  its  course — from  the  sur- 
face of  the  organ  to  which  its  filaments  are  distributed, 
and  no  matter  how  remotely  it  may  be  situated,  to  the 
spinal  or  cerebral  centre.  The  motor  impulse,  or  that 
which  supplies  the  force  that  causes  muscular  contrac- 
tion, is  efferent  in  its  course — from  the  cord  or  brain, 
or  both,  to  the  muscular  tissue,  upon  which  the  motor 
nervous  filaments  are  distributed. 

"  When  you  are  told  that  every  organ,  and  indeed 
every  one  of  the  bodily  tissues,  is  supplied  with,  and  is 
under  the  dominion  of,  the  nerves,  you  will  at  once 
infer  that  the  sensory  and  motor  filaments  must  neces- 
sarily communicate  with  each  other.  This  occurs  either 
in  the  gray  matter  of  the  spinal  cord,  which  is  called  its 
ganglion,  or  in  that  of  the  brain,  where  it  forms  the  cen- 
tral ganglia.  It  is  only  necessary  that  the  force  or  im- 
pression propagated  to  the  sensitive  filaments  of  the 
afferent  nerves  shall  be  conveyed  to  the  'gray  or  vesicu- 
lar matter  of  the  brain  or  the  cord,  when  it  is  acted  upon 
by  some  of  their  ganglia,  modified  and  returned  to  the 
organ  through  the  out-going  conductor,  the  efferent  or 
motor  nerve. 

*  Lectures  on  Obstetrics,  Page  263. 

f  North  American  Journal  of  Homoeopathy,  Vol.  13,  Page  2. 


54  HALE   ON   ABORTION. 

"  Here  is  the  whole  philosophy  of  reflex  action*  Every 
organ  is  connected  with  and  under  the  control  of  a  mass 
of  gray  neurine,  which  anatomists  call  a  ganglion,  no 
matter  whether  that  collection  of  nerve  vesicles  be 
found  in  the  brain,  the  spinal  cord,  or  in  the  ganglia 
of  the  great  sympathetic.  Sensitive  impressions  tele- 
graphed to,  modified  by,  and  returned  from  these  va- 
rious centres  to  the  same  or  any  other  organ  or  organs, 
furnish  all  the  detail  of  reflex  action." 

Our  space  will  not  permit  an  explanation  of  the 
physiological  or  healthy  relations  of  the  uterus  to  the 
cerebro-spinal  system.  Its  pathological  relations,  how- 
ever, come  within  the  limits  of  our  special  subject.  In 
order  to  be  systematic  we  should  classify  these  morbid 
relations  under  three  heads,  namely : 

1.  When  the  sensory  current  is  reflected  upon  the 
womb,  and  causes  various  modifications  of  its  healthy 
sensibility. 

2.  When  the  motor  current  is  reflected  upon  the 
womb,  causing  abnormal  or  normal  mobility. 

3.  When  both  currents  are  reflected  in  a  way  to 
modify  the  healthy  vascularify  of  that  organ. 

From  the  jwst  we  may  have  hysteralgia,  dysme- 
norrhoea,  "uterine  colics,"  super-sensitiveness  of  the 
uterus,  etc. 

From  the  second,  uterine  cramps,  spasms,  contractions, 
dilation  and  rigidity  of  the  cervix,  etc. 

From  the  third,  congestion,  inflammation,  and  their 
sequelae  of  leucorrhoaa,  ulceration,  etc. 

This  treatise  is,  however,  not  intended  to  be  suffi- 
ciently extensive  for  any  attempt  at  such  a  complete 
classification  of  the  causes  of  abortion.  I  shall,  there- 
fore, classify  them  under  two  heads. 

1.  Those  irritations  which,  originating  in  the  tissues, 
or  within  the  cavity  of  the  uterus,  cause  abnormal 


CAUSES    OF   ABORTION.  55 

influences  to  be  reflected  back  upon  itself,  with  suffi- 
cient force  to  cause  abortion. 

2.  Those  irritations  which  originate  in  other  organs 
and  are  reflected  upon  the  uterus,  so  as  to  cause  the 
expulsion  and  death  of  the  foetus. 

FIRST  CLASS. 

Parotidean. — In  Braithwaitd  s  Retrospect,  Part  xx. 
page  201,  a  case  of  abortion  is  mentioned,  which  seemed 
to  have  been  caused  by  a  metastasis  of  mumps.  The 
patient  was  a  lady  aged  twenty-five,  who  was  attacked 
with  cynanche-parotidea  when  advanced  just  beyond 
the  third  month  of  her  third  pregnancy.  She  had  gone 
her  full  time  in  her  previous  pregnancies.  After  a  day 
or  two  of  vaginal  discharge,  uterine  pains  and  haemor- 
rhage came  on  suddenly  in  the  night  and  a  foetus  was 
discharged.  The  hsemorrhage  continuing,  ergot  was 
given,  and  fifteen  hours  after  the  birth  of  the  foetus  the 
placenta  was  removed. 

Dr.  Salter,  who  reports  the  case,  remarks,  that  we 
have  abundant  experience  to  show  that  the  parotid 
glands,  when  diseased,  have  a  relation  to  the  testicles 
in  the  male  and  mammae  in  the  female.  The  mammary 
glands  have  a  well-known  sympathetic  relation  to  the 
ovaries :  and  thus  it  may  readily  be  supposed  that  in 
mumps  an  irritation  may  be  communicated  to  the  ute- 
rine system.  On  the  other  hand,  the  mammary  glands 
may  be  affected,  in  metastasis  of  mumps,  through  the 
ovaries.  It  is  difficult  to  decide  which  organ  is  prima- 
rily affected  by  the  reflex  influence  originating  in  the 
parotids ;  but  the  analogy  between  the  testes  and  the 
ovaries,  and  the  sympathy  of  the  breasts  with  the  ova- 
ries, go  rather  to  support  the  hypothesis  that  the  latter 
organs  fir»t  receive  the  metastatic  irritation. 


56  HALE   ON   ABORTION. 

Dr.  Bedford  and  Scanzoni  both  make  use  of  this 
reflex  influence :  the  latter  has  founded  upon  it  a 
method  of  inducing  premature  labor  by  irritation  of 
the  mammae. 

Thyroideal. — Cases  are  on  record,  and  some  have 
come  under  my  own  observation,  where  abortion  was 
apparently  caused  by  the  application  of  iodine  to  an 
enlarged  thyroid  gland.  All  irritations  of  this  gland 
should  be  avoided  during  pregnancy.  I  believe  I  was 
the  first  to  call  attention  to  the  sympathetic  relation  of 
this  gland  to  the  reproductive  organs,  in  a  paper  on 
that  subject  written  several  years  since.*  Subsequent 
investigations  appear  to  substantiate  my  views  on  that 
subject. 

Mammary. — :Tyler  Smith  states  that  he  has  seen 
abortion  caused  by  irritation  of  the  mammary  nerves. 
Instances  of  this  are  when  abortions  occur  from  pro- 
longed lactation  during  pregnancy.  That  it  is  not 
mere  weakness  or  exhaustion  in  some  of  these  cases  is 
proved  by  the  fact  that  the  mammary  secretion  may 
cease  upon  the  occurrence  of  impregnation,  but  that  a 
plentiful  supply  of  milk  returns  after  the  recurrence  of 
abortion.  Blisters  or  sinapisms,  or  even  hot  fomenta- 
tions to  the  breasts,  may  irritate  the  pregnant  uterus. 
It  is  well  known  that  contractions  of  the  womb  are 
excited,  after  labor,  from  irritation  of  the  mammae. 

Gasti*ic. — Although  it  is  surprising  what  an  amount 
of  nausea  and  vomiting  the  uterus  will  bear  without 
being  excited  to  expel  its  contents,  yet  there  are  many 
cases  recorded  in  which  abortion  has  been  apparently 
brought  on  by  excessive  vomiting  during  pregnancy. 
'I  have  known  abortion  to  be  caused  by  the  excessive 

*  North  American  Journal  of  Homoeopathy,  Vol.  12,  page  375. 


CAUSES    OF   ABORTION.  57" 

vomiting  induced  by  lobelia.  It  is  true  that  in  some 
cases  the  mechanical  irritation  may  be  the  main  cause, 
but  there  are  many  in  which  it  undoubtedly  occurs  as 
a  reflex  pathological  phenomenon. 

Dental. — Irritation  of  the  trifacial  nerves  may  pro- 
duce abortion.  This  happens  sometimes  from  the  irri- 
tation of  cutting  the  wisdom  teeth,  the  extraction  of  a 
decayed  tooth,  or  the  irritation  of  a  constant  odon- 
talgia.  It  is  advised  by  many  of  the  older  obstetric 
writers  to  avoid  the  extraction  of  teeth  in  a  pregnant 
woman. 

Renal. — A  cute  nephritis,  the  passage  of  calculi,  or 
irritation  of  the  kidneys  in  albuminuria,  are  said  to  be 
sometime  causes  of  abortion. 

Vesical. — Cystitis — idiopathic,  or  from  the  poison- 
ous action  of  drugs — may  be  a  cause  of  abortion.  Tur- 
pentine, canthariS)  and  other  medicines,  may  induce  such 
irritation  of  tjie  bladder  as  to  bring  on  miscarriage ; 
so,  also,  the  presence  of  stone  in  the  bladder. 

Rectal. — The  production  of  abortion  by  the  irritation 
of  the  rectal  nerves  is  a  well-recognized  occurrence.  It 
may  happen  from  hoemorrhoidal  inflammation,  the  irri- 
tation of  ascarides,  the  action  of  violent  purgatives, 
diarrhoea,  dysentery,  or  the  opposite  condition  of  exces- 
sive constipation,  stimulating  enemata,  etc.  Whitehead, 
under  the  head  of  "  Functional  Impediments  of  the 
Bowels,"  mentions  many  instances  of  abortion  from 
the  irritation  of  retained  foecal  matter.  He  says : 
"  The  symptoms  are  distension  and  tenderness  of  the 
abdomen,  commonly  attributed  by  the  patients  to  flatu-* 
lence,  of  which  they  are  constantly  endeavoring  to  re- 
lieve themselves  by  eructation.  The  abdomen  is  some- 
times as  large,  under  these  circumstances,  in  the  middle, 
as  it  should  be  at  the  end  of  pregnancy.  There  is  a 


58  HALE    ON    ABORTION. 

constant  inclination  to  relieve  the  bowels,  the  evacua- 
tions, which  are  thin  and  scanty,  being  accompanied  by 
violent  straining  efforts.     This  action  is  not  long  in 
being  extended  to  the  uterus,  which  becomes  affected 
with  pains  of  an  intermittent  and  expulsive  character, 
creating  the  belief  that  abortion  is  about  to  happen. 
The  real  cause  of  these  disturbances  is  accumulation  of 
fceces  in  the  third  turn  of  the  colon,  accompanied  with 
flatulent  distension  of  that  portion  of  the  bowel  immedi- 
ately above  the   seat  of  obstruction.     This  cause  of 
abortion  does  not  generally  occur  before  the  fourth 
month,  for  not  until  that  time  does  the  womb  attain 
sufficient  size  to  act  as  an  impediment  to  the  passage  of 
foecal  matter  through  the  rectum.    The  haemorrhage  in 
this  description  of  cases   is   apt  to  be   profuse,   and 
restrained  with  difficulty."     Frecal  accumulations  may 
also  cause  abortion,  by  producing  that  displacement  of 
the  uterus  known  as  retroversion,  a  condition  treated  of 
in  another  place.     Aloes,  podophyllum,  mercury,  and 
their  analogues,  may  cause  abortion  by  the  rectal  irri- 
tation they  produce. 

Vaginal. — Acute  vaginitis,  gonorrhoeal  or  idiopathic, 
will  sometimes  cause  abortion.  Mechanical  irritation 
of  the  vagina,  by  plugging,  coition,  or  ill-fitting  pessa- 
ries, or  irritating  injections,  may  have  the  same  effect. 
Vaginismus,  a  painful  spasmodic  affection,  which  has 
attracted  much  attention  of  late,  is  not  only  a  frequent 
cause  of  sterility,  but  of  abortion.  Dr.  Helnmth*  has 
given  us  a  vivid  example  of  this  condition,  in  a  recent 
.article.  The  induction  of  abortion  by  means  of  the 
colpeurynter  will  be  considered  in  another  place. 

Ovarian. — Any  irritation  or  excitement  of  the  ovaries 
is  reflected  upon  the  uterus,  mamma},  or  thyroid  gland. 

*See  Western  Homoeopathic  Observer,  Vol.  1. 


CAUSES    OF   ABOKTION.  59 

In  the  unimpregnated  state,  the  uterus  generally  re- 
ceives the  reflex  ovarian  influendl ;  when  it  occurs 
during  pregnancy  it  is  an  abnormal  phenomenon, 
and  is  liable  to  cause  miscarriage.  If  this  influence 
is  received  by  the  mammae  or  thyroid,  the  uterus  is 
left  to  go  on  with  its  normal  development.  In  many 
instances  the  simple  occurrence  of  the  menstrual  nidus 
has  been  sufficient  to  cause  abortion.  This  is  one  form 
of  that  disease  called  "  habitual  abortion."  The  uterus 
must  first  be  in  a  debilitated,  irritable  condition,  in 
order  to  be  seriously  affected  by  this  influence.  The 
ovarian  irritation  may  be  perfectly  normal  all  the  time, 
or  it  may  be  abnormal,  consequent  on  diseased  condi- 
tions, or  the  toxical  effects  of  drugs.  Thus  if  canthar- 
ides,  camabis  indica,  apis  mel,  or  similarly  acting  drugs, 
be  given  in  pathogenetic  doses,  they  may  set  up  an 
irritation  in  the  ovaries  which  shall  be  reflected  upon 
the  uterus  with  such  force  as  to  cause  it  to  take  on 
diastaltic  action.  Certain  diseases  of  the  ovaries  have 
the  same  effect,  namely — inflammation,  congestion, 
suppuration,  etc.  Those  diseases  which  can  act  as  di- 
rect or  mechanical  irritants  to  the  uterus,  are  enlarge- 
ments, from  cystic  and  other  growth,  dropsy,  etc. 

SECOND   CLASS.  ' 

Uterine. — This  class  includes  the  following,  namely : 

(a)  Diseases  of  the  uterus,  functional  and  organic. 

(&)  Displacements  of  the  uterus. 

(c)  Death  of  the  foetus. 

The  uterus  is  endowed  with  what  is  termed  peristaltic 
action — a  peculiar  vermicular  motion  or  contraction, 
which  is  called  by  Tyler  Smith,  "ganglionic  motor 
action."  "When  any  part  of  a  muscular  organ,  sup- 
plied in  whole  or  in  part  by  the  ganglionic  system  of 


60  HALE    ON   ABORTION. 

nerves,  is  irritated,  the  contraction  which  ensues  gene- 
rally spreads  in  a  vermicular  manner  to  a  distance  from 
the  point  of  irritation,  and  continues  for  some  time 
after  the  exciting  cause  is  removed.  The  uterus  is 
eminently  endowed  with  the  peristaltic  form  of  con- 
traction. When  one  point  of  the  uterus  is  stimulated, 
through  the  abdominal  parietes,  or  by  the  introduction 
of  the  hand  into  the  uterus,  the'  contraction  excited 
extends  to  the  whole  organ."  Dr.  Smith  has  seen  this 
action  occur  after  death,  in  animals,  and  he  asserts  that 
the  uterus  seems  capable  of  expelling  the  foetus  by  peri- 
staltic action  alone.  In  cases  of  paraplegia  from  disease 
of  the  lower  part  of  the  spinal  marrow,  or  in  animals 
reduced  to  the  same  state  by  experiment,  the  peristaltic 
action  is  the  chief  power  remaining  in  the  uterus.  In 
such  cases  delivery  has  been  effected  in  an  imperfect 
manner  by  the  peristaltic  action  of  the  uterus  or  by  the 
application  of  galvanism  to  the  organ.  It  is  not  stated, 
however,  how  much  of  the  spinal  marrow  must  be  des- 
troyed before  the  reflex  ordisastaltic  action  of  the  uterus 
ceases.  .It  is  not  probable  that  this  peristaltic  action 
can  exist  to  any  extent,  unconnected  with  the  reflex 
spinal  influence.  In  cases  of  labor  and  abortion,  the 
two  forms  of  action  exist  in  combination.  The  motor 
nerves  of  the  uterus  are  in  relation  with  the  mammary, 
pubic,  rectal,  pneumogastric,  ovarian,  vaginal,  and  the 
nerves  of  the  os  and  cervix  uteri,  as  incident  excitor 
nerves.  There  can  be  no  doubt  that  in  an  organ  thus 
subject  to  reflex  action,  its  own  nerves  are  excitors,  and 
that  in  all-  contractions  of  the  uterus  excited  by  irrita- 
tion of  its  external  surface,  or  of  the  os  and  cervix,  by 
disease  or  otherwise,  the  uterine  actions  are  both  reflex 
and  peristaltic.  It  is  indeed  a  question  if  any  pure 
spinal  fibres  reach  or  proceed  from  the  uterus  unmixed 


CAUSES    OF    ABORTION.  61 

with  fibres  from  the  ganglionic.  Any  pathological 
condition  of  the  uterus,  which  is  capable  of  exciting 
these  reflex-spinal  and  ganglionic-motor  actions,  may  be 
a  cause  of  abortion  at  any  period  of  pregnancy. 

Functional  diseases  of  the  uterus,  are  those  in  which 
no  change  in  structure  has  yet  appeared,  although  fhe 
condition  existing  may  lead  to  such  lesion.  The  older 
writers  laid  much  stress  on  the  opposite  states,  which 
they  termed  rigidity  and  laxity  of  the  muscular  tissue 
of  the  womb.  We  cannot  dispute  the  fact  that  such  a 
condition  may  exist  as  idiopathic  affections,  i.  e.,  de- 
pending upon  the  same  general  state  of  muscular  fibre. 
But  it  may  obtain  from  purely  local  causes,  namely:  an 
exhausting  discharge  from  the  mucous  tissues  of  the 
organ  itself — as  functional  leucorrhoea.  But  as  leucor- 
rhcea  may  be  functional,  and  also  dependent  on  organic 
changes  in  the  uterine  tissues,  we  will  proceed  to  con- 
sider that  disease,  as  it  is  the  connecting  link  between 
the  two  classes  of  uterine  diseases. 


SECTION    V. 

FUNCTIONAL    DISEASES    OF   THE   UTERUS. 

Congestion  of  the  Uterine  Circulation. — According  to 
Whitehead  this  appears  to  prevail  as  the  immediate 
cause  of  abortion  in  one  out  of  every  twenty-five  cases. 
He  believes  the  average  is  even  greater.  Those  in 
whom  the  venous  capillary  function  is  naturally  below 
par,  indicating  predisposition  to  local  congestion,  are 
most  frequently  the  subjects  of  it.  The  symptoms  which 


62  HALE    ON    ABORTION. 

. 

usually  manifest  themselves  after  the  period  of  quick- 
ening, from  the  end  of  the  fourth  to  the  eighth  month 
of  pregnancy,  are — immoderate  and  painful  distension  of 
the  abdomen,  generally  attributed  by  the  patient  to 
the  accumulation  of  Wind  in  the  bowels ;  a  pulsative 
movement  extending  over  the  whole  cavity ;  sense  of 
weight  and  bearing  down ;  intermittent  pains  in  the 
loins,  like  those  of  labor,  and  occasionally  escape  of 
blood  from  the  vagina.  There  is  also  distension  of  the 
pubic,  spermatic,  hsemorrhoidal,  and  all  the  pelvic 
veins,  and  sometimes  those  of  the  lower  extremities. 
On  examination,  the  vagina  is  found  hot  and  turgid, 
and  the  cervix  uteri  tumid  and  varicose.  When  this 
state  is  allowed  to  exist  for  a  length  of  time,  local  phle- 
bitis may  take  place,  resulting  in  varicose  ulceration  of 
the  cervix ;  or  the  inflammation  may  extend  through 
the  entire  organ,  and  eventually  to  the  uterine  perito- 
neum, ending  in  effusion,  etc. 

Leucorrluw. 

»!  The  frequency  of  leucorrhoea  during  pregnancy,  and 
the  many  unpleasant  symptoms  to  which  it  gives  rise, 
should  lead  us  to  study  more  closely  the  connection 
between  that  disorder  and  abortion. 

The  valuable  monograph  of  Dr.  Tyler  Smith  on 
Leucorrhoea  leaves  but  little  to  be  desired  relative  to 
the  true  pathology  of  the  abnormal  discharges  which 
go  under  that  name.  The  limits  of  this  work  will  not 
permit  me  to  give  more  than  a  cursory  glance  at  the 
divisions  of  leucorrhoea;  our  main  purpose  is  to  con- 
sider the  influence  it  has  on  the  causes  of  utero-gestation. 
But  the  treatment  of  this  disease  will  in  time  be  so  inti- 
mately connected  with  a  true  understanding  of  the 
nature  and  locality  of  the  discharge,  that  we  cannot  for- 


CAUSES    OF   ABOETION.  63 

bear  giving  some  general  idea  of  the  classification  of 
the  varieties  of  this  malady. 

"All  pathology  has  its  basis  in  physiology.  The 
demonstration  of  two  very  differently  organized  surfaces 
in  the  vagina,  and  in  the  canal  of  the  cervix  uteri,  with 
the  existence  of  two  very  distinct  forms  of  secretion, 
naturally  lead  us  to  the  consideration  of  two  principal 
forms  of  leucorrhcea.  But  at  this  point  it  may  be  well 
to  revert  for  a  moment  to  the  special  difference  which 
exists  between  the  vagina  and  the  cervical  canal.  The 
lining  membrane  of  the  vagina  approaches  in  organiza- 
tion to  the  skin ;  it  is  covered  by  a  thick  layer  of  scaly 
epithelium ;  it  contains  in  the  greater  part  of  its  surface 
few,  if  any,  mucous  follicles  or  glands ;  its  secretion  is 
acid,  consisting  entirely  of  plasma  and  epithelium,  and 
the  chief  object  of  the  secretion  is  the  lubrication  of  the 
surface  upon  which  it  is  formed. 

"  On  the  other  hand,  the  lining  of  the  canal  of  the 
cervix,  is  a  true  mucous  membrane :  it  is  covered  in 
great  part  by  cylinder  epithelium ;  it  abounds  with 
immense  numbers  of  mucous  follicles,  having  a  special 
arrangement ;  it  pours  forth  a  true  mucous  secretion, 
alkaline  in  character,  and  consisting  of  mucous  corpus- 
cles and  plasma,  with  little  or  no  epithelium,  and  this 
secretion  has  special  uses  to  perform  in  the  unimpreg- 
nated  state,  and  in  pregnancy,  and  parturition."* 

We  here  have  presented  the  anatomico-physiological 
character  of  the  vagina,  and  canal  of  the  cervix  uteri. 
So  long  as  the  secretions  from  these  surfaces  remain 
within  physiological  limits,  no  disease  is  present :  but 
the  moment  these  secretions  become  abnormal  in  quan- 
tity or  quality,  the  result  is  Leucorrhoea. 

Leucorrhoea  admits  of  the  same  divisions  as  set  forth 
in  the  above  quotation.  The  first  and  most  important 
is  the  Mucous  variety,  consisting  chiefly  of  mucus-cor- 

*  Tyler  Smith  on  Leucorrhoea. 


64  HALE    ON    ABORTION. 

puscles  and  plasma,  and  secreted  chiefly  by  the  follicu- 
lar  canal  of  the  cervix.  The  second  is  the  Epithelial 
variety,  in  which  the  discharge  is  vaginal,  or  is  secreted 
by  the  vaginal  portion  of  the  os  and  cervix,  and  con- 
sistSj  for  the  most  part,  of  scaly  epithelium  and  its  debris. 

These  two  varieties  may,  of  course,  exist  in  various 
degrees  of  combination.  Sometimes  the  one  and  some- 
times the  other  preponderates,-  or  is  the  original  affec- 
tion. The  old  division  of  uterine  leucorrhoea,  as  arising 
from  the  cavity  of  the  fundus,  is  now  obsolete — such 
discharge  rarely  occurs.  In  certain  cases  of  inenor- 
rhagia/the  periodical  sanguineous  discharge  is  converted 
into  a  constant  colored  discharge,  in  which  may  appear 
some  mucus,  but  hardly  enough  to  constitute  a  leu- 
corrhoea. 

Cervical  or  Mucous  Leucoi^rhoea. — This  most  com- 
mon form  of  leucorrhcea  is,  when  simple  and  uncompli- 
cated, the  result  of  a  morbid  activity  of  the  glandular 
cervix.  Instead  of  the  discharge  of  the  plug  of  mucus 
at  the  catamenial  period,  a  constant  discharge  is  set  up. 
The  glandular  portion  of  the  canal  of  the  cervix  is  the 
chief  source  of  the  discharge  ;  it  is  a  special  secretion, 
elaborated  by  those  glands. 

In  recent  cases  of  cervical  leucorrhcea,  when  the  dis- 
order consists  merely  of  a  hyper-secretion  of  the  mucous 
follicles,  without  any  manifest  lesion  of  structure,  the 
cervical  discharge  is  found  (on  examination  with  the 
speculum)  hanging  at  the  os  uteri,  or  adhering  to  its 
vaginal  portion,  and  is  almost  always  viscid  and  trans- 
parent. It  may  be  drawn  out  in  long  tenacious  threads 
of  the  utmost  clearness,  unless  in  course  of  pregnancy, 
or  abnormal  state  of  the  vagina,  when  it  is  rendered 
opaque  by  the  acid  vaginal  mucus.  This  string  of 
mucus  sometimes  extends  the  whole  length  of  the 


CAUSES    OF    ABORTION.  65 

vagina,  and  even  extends  from  that  passage.  This 
secretion  is  always  alkaline,  in  contradistinction  to  the 
vaginal  secretions  which  are  acid. 

In  severe  or  chronic  cases  of  this  form  of  leucorrhoea, 
the  alkaline  cervical  niucus  is  mixed  with  pus  and 
blood,  owing  to  the  irritable  and  more  deeply  diseased 
condition  of  the  glands  of  the  canal  of  the  cervix.  In 
some  cases,  the  exudation  of  blood  from  the  canal  of 
the  cervix  is  so  constant  that  it  is.  apt  to  be  mistaken 
for  rnenorrhagia.  In  other  cases  of  cervical  leucorrhoea 
the-  secretion  is  so  profuse  and  watery  that  the  traces 
of  viscidity  are  nearly  lost.  Instead  of  the  mucus  and 
plasma,  a  watery  serum  is  poured  out  in  large  quan- 
tities. 

The  quantity  of  mucus  or  serum  lost  in  cases  of  cer- 
vical leucorrhoea  is  often  so  considerable  as  to  prove  a 
serious  drain  to  the  constitution,  and  set  up  functional 
or  more  serious  disorders  in  different  parts  of  the  body. 
The  serous  secretion  in  particular  is  often  a  source  of 
great  debility.  Patients  suffering  from  either  of  the 
above  forms  may  become  hectic  from  purulent  secre- 
tion and  absorption,  or  rendered  anaemic  from  the  loss 
of  blood.  The  symptoms  arising  from  cervical  leucorr- 
hcea  are  numerous  and  changeable,  dependent  on  the 
amount  of  local  irritation,  functional  derangement  of 
other  organs,  or  the  loss  of  tone  in  the  muscular  or 
nervous  system. 

Sequelae  of  Cervical  Leucorrhoea. — It  is  well  known 
by  the  reading  men  of  the  medical  profession,  that 
writers  on  uterine  pathology  are  divide  into  antagon- 
istic schools,  namely,  (1)  those  who,  under  the  leader- 
ship of  Bennet,  believe  nearly  all  abnormal  discharges 
from  the  uterus  are  the  result  of  inflammation  and 
ulceration,  and  (2)  those  who  adopt  the  theory  of  Tyler 
5 


66  HALE    ON    ABORTION. 

Smith,  that  the  ulceration  is  the  result  of  abnormal 
discharges  from  the  cervical  canal  and  its  glandular 
apparatus. 

When  these  conditions  occur  as  actual  sequelae  of 
cervical  leucorrhoea,  the  following  is  their  order  of 
appearance.  I  quote  from  Dr.  Tyler  Smith. 

"  By  observing  cases  of  mucous  or  cervical  leucorr- 
hcea,  under  every  variety  of  circumstances,  we  may 
obtain  a  tolerably  correct  knowledge  of  the  different 
stages  of  the  disease,  and  we  may  learn  the  order  in 
which  its  sequelae  makes  its  appearance  when  it  is 
allowed  to  run  its  course  unchecked  for  a  considerable 
time.  In  the  first  place  there  is  simply  an  increase  of 
the  secretion  of  the  cervical  mucus.  Instead  of  the 
formation  of  the  plug  after  each  monthly  period,  there 
is  a  constant  escape  of  thick  mucus  from  the  os  uteri. 
But  in  this  phase  of  the  disorder  there  is  little  constitu- 
tional or  local  disturbance.  The  size  of  the  os  and 
cervix  is  not  increased,  and  the  surface  of  the  os 
remains  quite  natural,  both  as  regards  volume  and 
color.  After  a  time  the  os  uteri  gapes ;  there  is  relax- 
ation of  the  cervix,  the  upper  part  of  the  vagina  loses 
its  tone,  and  some  amount  of  prolapsus  generally  occurs. 
With  this  the  ring  of  superficial  redness  slowly  passes 
on  to  the  destruction  of  epithelium ;  then  the  loss  of 
the  villi  takes  place,  and  the  formation  of  the  granular 
surface  upon  their  base  occurs.  The  whole  of  the  os 
and  cervix  now  becomes  swollen  and  turgid,  induration 
commences,  and  fibrinous  deposit  in  the  substance  of 
the  cervix  frequently  takes  place.  The  sensibility  of 
the  different  portions  of  the  utero-vaginal  canal  varies 
greatly  in  different  cases.  In  some  the  abraded  or 
hypertrophied  os  uteri  is  exquisitely  tender,  while  iii 
others  its  sensibility  is  little,  if  at  all,  increased.  In 
some  cases  of  leucorrhoea,  in  which  abrasion  occurs,  the 
whole  of  the  os  uteri  and  the  cervix  hangs  into  the 
vagina,  completely  denuded  of  its  integumentary  cover- 


CAUSES    OF   ABOETION.  67 

ing,  but  there  is  no  great  enlargement  of  the  parts. 
In  others  there  is  considerable  hypertrophy  without 
any  destruction  of  epithelium  or  loss  of  surface." 

All  the  conditions  above  mentioned  as  being  caused 
by  cervical  leucorrhoea  may  arise  from  other  causes. 
Dr.  Bennet  insists  that  they  arise  from  inflammation  of 
the  cervix. 

It  is  of  considerable  importance  to  the  practical 
physician  whether  these  conditions  are  primary  or 
secondary  effects :  the  selection  of  the  remedy  depends 
considerably  upon  the  theory  adopted.  The  contro- 
versy is  yet  undecided,  and  probably  will  not  be  until 
personal  asperity  and  prejudice  is  laid  aside,  and  all 
seek  conscientiously  for  truth.  As  in  nearly  all  other 
controversies,  neither  party  has  all  the  truth  on  his 
side.  I  am  inclined  to  the  belief  that-  either  leucor- 
rhoea or  inflammation  may  be  the  primary  affection. 
An  inflammation  of  the  cervix,  or  an  ulcer  thereon, 
may  cause  cervical  leucorrhoea,  and.  vice  versa.  The 
best  we  can  do,  in  the  present  state  of  our  knowledge, 
is  to  judge  from  the  history  of  the  case,  and  a  careful 
examination  with  the  speculum,  which  has  the  priority. 

Vaginal  or  Epithelial  Leucorrhoea. — This  discharge 
has  its  origin  in  the  muco-cutaneous  lining  of  the  vagina 
and  the  portion  of  this  membrane  reflected  on  the  ex- 
ternal surface  of  the  cervix  to  the  margin  of  the  os 
uteri.  In  strictly  vaginal  leucorrhoea  there  may  be  no 
discharge  whatever  issuing  from  the  canal  of  the  cervix, 
and  in  some  cases  the  secretion  of  the  cervix  seems 
almost  suspended,  the  os  uteri  appearing  drier  than 
natural,  and  no  mucus  being  visible  between  the  labia 
uteri.  In  others  the  cervical  glands  are  excited  by  the 
condition  of  the  vagina,  and  secrete  copiously  a  mixed 
epithelial  and  mucous  leucorrhoea,  from  the  union  of 


68  HALE    ON    ABORTION. 

the  two  kinds  of  discharge.  The  discharge  in  vaginal 
leucorrhoea  may  arise,  chiefly,  either  from  the  lower  part 
of  the  vaginal  membrane  or  from  that  part  which  is 
reflected  upon  the  cervix,  but  in  severe  cases  the  whole 
surface  of  the  vagina  is  involved.  In  simple  acute 
cases  of  vaginal  leueorrtaea  the  discharge  is  epithelial, 
made  up  of  imperfect  and  perfect  scales.  In  severe 
and  chronic  cases,  pun  is  mixed  with  the  epithelial  mat- 
ter ;  for  the  villi  become  affected  and  the  pus  is  formed 
upon  the  sub  epithelial  or  villous  surface.  In  some 
cases  portions  of  the  vaginal  surface  may  be  so  abraded 
that  blood  globules  escape  and  mix  with  the  other  con- 
stituents of  the  vaginal  discharge.  In  one  form  of 
vaginal  leucorrhcea  but  little  fluid  discharge  appears, 
but  the  vaginal  walls  are  coated  over  with  a  white 
membrane,  which  may  be  detached  in  large  shreds  or 
pieces,  composed  of  epithelium  in  which  the  parchment- 
like  arrangement  of  the  scales  is  perfectly  preserved. 
These  laminae  frequently  have  upon  them  marks  of  the 
rugae  of  the  vagina,  and  their  under  surfaces  are  rough 
from  the  indentations  of  the  vaginal  papillae.  This 
may  be  termed  a  membranous  form  of  leucorrhcea,  and 
occurs  oftenest  in  cases  of  pregnancy.  The  vagina  may 
be  attacked  with  the  diphtheritic  poison,  and  secrete 
a  membrane  having  that  character.  In  some  cases  of 
vaginal  leucorrhoaa,  the  irritation  is  intense  and  annoy 
ing,  assuming  the  form  of  pruritus  vulvce.  This  latter 
symptom  is,  however,  oftener  caused  by  an  aphthous- 
inflammation  of  the  lining  membrane  of  the  vagina  and 
vulva.  I  have  known  cases  in  which  abortion  appeared 
to  be  caused  by  this  symptom  alone,  the  severe  reflex 
irritation  being  sufficient  to  set  up  expulsive  action  in 
the  uterus. 


CAUSES    OP    ABORTION.  69 

The  frequency  of  leucorrhcea  during  pregnancy  has 
been  alluded  to.  Whitehead  found,  in  2,000  cases  1,116 
in  which  leucorrhoea  was  present.  Out  of  the  2,000 
cases,  747  had  abortions,  and  of  this  latter  number, 
only  172  cases  of  abortion  could  be  assigned  to  specified 
causes — leaving  575  cases  out  of  1,116  "having  leucor- 
rhoea. This  is  a  large  percentage — larger  than  we  ever 
meet  in  general  practice.  In  many  of  these  cases,  per- 
haps a  majority,  the  discharge  was  probably  due  to 
ulceration. 

Gonorrhoea. 

This  should  not  be  overlooked  when  we  are  consid- 
ering the  causes  of  abortion.  The  uterus  is  more  com- 
monly affected  by  the  gonorrhoeal  poison  than  has  been 
supposed.  Whitehead  asserts  that  this  disease  more 
commonly  affects  the  uterus  than  the  vagina.  This  opin- 
ion is  at  variance  with  what  has  usually  been  taught. 
That  writer  contends  that  the  gonorrhoeal  virus,  from 
physiological  causes,  is  liable  to  be  carried  immediately 
to  the  highest  part  of  the  canal,  and  forcibly  projected 
upon  the  lowest  extremity  of  the  uterus,  which  organ 
also,  at  this  juncture,  is  in  a  state  eminently  calculated 
speedily  to  absorb  it ;  besides,  the*  normal  secretion  of 
the  vagina  possesses  properties  which  are  capable,  to  a 
certain  extent,  of  destroying  or  materially  modifying 
the  virulency  of  the  poison,  and  of  thus  protecting  the 
vaginal  surface  from  its  immediate  influence.  The 
urethral  orifice,  however,  does  not  seem  to  be  provided 
with  this  protection  to  any  degree,  and  is  therefore 
much  more  susceptible  to  the  action  of  specific  inocula- 
tion. In  nine  unimpregnated  women  affected  with 
gonorrhoea,  seven  had  inflammation,  with  abrasion  of 
the  os  uteri,  and  in  the  remaining  two,  the  upper 
vaginal  surface  and  urethra  were  affected. 


70  HALE    ON    ABORTION. 

Gonorrhoea  first  affects  the  uterus  by  causing  super- 
ficial inflammation  of  the  lips  of  the  os  and  the  com- 
mencement of  the  internal  cervix.  The  inflammation 
seems  to  affect  principally  the  small  mucous  follicles 
with  which  the  surface  is  closely  studded.  "  A  small 
red  patch  is  first  perceived ;  sometimes  there  are  two 
or  three  isolated  spots  which  extend  and  soon  run  to- 
gether, forming  one  patch,  of  variable  size  in  different 
cases  and  in  different  stages  of  the  complaint,  and 
generally  of  irregular  shape.  On  removing  the  thick 
secretion  with  which  this  is  covered,  the  surface  appears 
to  consist  of  minute  granules,  equally  dispersed  over 
every  part  of  it ;  the  abrasion  is  bounded  by  a  margin 
not  very  distinctly  defined,  running  imperceptibly  into 
the  erysipelatous  redness  which  surrounds  the  sore ; 
this  extends  to  some  distance  upon  the  cervix,  the 
whole  of  which  is  more  or  less  tumid,  but  not  painful 
to  the  touch."  In  plethoric  women  the  symptoms  are 
often  very  violent,  the  inflammation  being  severe,  and 
the  ulceration  of  an  irritable  character,  throwing  off 
large  quantities  of  pus  and  often  causing  much  fever. 

If  the  infection  be  contracted  during  pregnancy, 
abortion  is  liable  to  take  place  during  the  acute  stage 
of  the  complaint  from  the  intense  uterine  irritation.  If 
the  disease  existed  previous  to  gestation,  it  may  have 
caused  chronic  •  endo-uteritis,  or  an  ulcerated  condition 
of  the  cervix,  both  of  which  conditions  are  quite  serious, 
and  are  likely  to  be  cause  of  abortion  at  any  period  of 
pregnancy. 

It  is  Whitehead's  opinion  that  gonorrhoeal  affections 
in  women  are  rarely  cured ;  that  they  are  frequently 
the  cause  of  induration,  fissured  ulcer,  and  chronic  in- 
flammation of  the  deeper  seated  tissues. 


CAUSES    OF    ABORTION. 


SECTION    VI. 

ORGANIC  DISEASES  OF  THE  UTERUS  AND  CERVIX. 

Ulceration  of  the  Cervix. — Whitehead  refers  to  a 
table  containing  the  records  of  400  cases  of  abortion 
and  threatened  abortion,  "  In  all  which,  disease  of  the 
uterus  was  an  accompanying  condition,  and  for  which 
no  other  cause  could  be  assigned  for  the  disturbance 
complained  of,  the  average  occurrence  of  the  superficial 
granulating  ulcer,  or  of  diffuse  inflammation  of  the 
cervix,  amounted  to  26  in  every  hundred.  In  the 
majority  of  these,  the  event  happened  between  the  mid- 
dle of  the  sixth  and  the  middle  of  the  ninth  month. 
In  some,  however,  the  symptoms  commenced  earlier." 

This  would  seem  to  indicate  that  ulceration  of  the 
cervix  was  better  tolerated  in  the  earlier,  than  in  the 
later  months  of  pregnancy.  In  several  cases,  recorded 
by  Bennet,*  the  abortions,  or  threatened  abortions, 
occurred  as  often  in  the  first,  as  in  the  last  three  months 
of  gestation. 

Ulceration  of  the  cervix  may  be  considered  as  one 
of  the  chief  causes  of  abortion.  Bennet  thus  sums  up 
his  experience  in  the  matter  : 

"Abortion  is  often  occasioned  by  inflammatory  ulcer- 
ation of  the  cervix,  and  likewise  often  occasions  it.  Jn 
the  latter  case,  abortion  occurs  accidentally,  under  the 
influence  of  some  of  its  generally  recognized  causes, 
and  leaves  behind  a  morbid  state  of  the  cervix  and  its 
cavity.  Local  disease  of  this  nature  may  follow  an 

*  Diseases  of  the  Uterus. 


72  HALE   ON    ABORTION. 

abortion  of  the  simplest  kind,  one  from  which  the 
patient  rallies  in  a  few  days,  although  it  is  more  gene- 
rally the  result  of  those  that  are  accompanied  by  inflam- 
matory and  hseniorrhagic  symptoms.  Ulcerative  disease 
of  the  cervix,  when  once  established,  from  whatever 
cause,  is  itself  a  frequent  cause  of  abortion.  When 
abortion  is  the  result  of  the  actual  existence  of  the 
inflammatory  disease,  it  may  be  produced  in  various 
ways.  The  vitality  of  the  womb  may  be  so  modified 
in  the  earlier  stage  of  pregnancy,  by  the  existence  of 
the  disease,  that  the  foetal  germ  dies,  in  which  case  it 
is  expelled  along  with  the  membranes,  or  it  is  partly 
or  entirely  absorbed,  the  membranes  'continuing  to 
enlarge  for  some  months,  and  being  eventually  expelled 
under  the  form  of  a  mole,  or  false  conception ;  or  the 
pregnancy  may  advance  to  a  farther  period,  until  the 
third  or  fourth  month,  when  the  womb  becoming  too 
irritable,  or  being  unable  to  develop  itself,  or  the  foetus 
dying,  the  membranes  separate,  flooding  ensues,  and 
the  contents  of  the  uterus  are  expelled.  At  a  later 
stage  still,  when  the  muscular  structure  of  the  womb  is 
more  fully  developed,  the  presence  of  inflammation  at 
its  mouth  may  bring  on  strong  reflex  action,  and  occa- 
sion premature  confinement,  independently  of  any  dis- 
ease of  the  child  or  of  its  membrane. 

"  Abortions,  no  doubt,  frequently  occur  under  the 
influence  of  accidental  causes  alone,  and  of  constitutional 
cachexia,  such  as  scrofula  and  syphilis,  without  there 
being  any  local  disease  of  the  cervix.  It  may,  however, 
be  laid  down  as  a  rule,  that  a  great  majority  of  abor- 
tions which  are  preceded  or  followed  by  morbid  symp- 
toms, and  of  those  which  occur  spontaneously,  without 
any  evident  cause,  and  in  the  absence  of  uterine  tumor 
01^  constitutional  cachexise,  are  occasioned  by  inflamma- 
tory disease  of  the  cervix.  It  may  also  be  considered 
as  all  but  certain,  that  inflammatory  and  ulcerative  dis- 
ease of  the  cervix  exists  when  abortions  quickly  suc- 
ceed one  another,  and  when  a  female  does  not  seem 
able  to  carry  the  product  of  impregnation  to  the  full 
time." 


CAUSES    OF    ABOKTION.  73 

According  to  the  same  author,  "  inflammatory  ulcer 
ation,  during  the  pregnant  state,  is  by  no  means  neces- 
sarily followed  by  abortion."  Gestation  may  go  on  till 
full  time,  wHen  no  remedial  treatment  is  resorted  to ; 
or  the  ulceration  may  be  treated  by  local  applications, 
and  cured,  without  interfering  with  the  course  of  preg- 
nancy. 

Bennet  also  says  that  "  instrumental  examination  of 
females  [women  ?]  laboring  under  inflammatory  ulcera- 
tion of  the  cervix,  during  pregnancy,  is  unattended 
with  any  risk,  either  to  the  mother  or  to  the  foetus,  and 
it  is  absolutely  necessary,  in  order  not  only  to  fully 
recognize  the  disease,  but  also  to  treat  it." 

This  statement  I  have  often  verified  in  practice.  The 
speculum  should  be  generally  resorted  to  in  cases  of 
threatened  abortion. 

" The  simple  granulating  ulcer"  says  Whitehead, 
"  may  be  confined  to  one  labium  only,  the  other  being 
perfectly  normal.  More  frequently,  however,  it  impli- 
cates both  at  the  same  time,  extending  to  some  distance 
up  the  external  cervix,  and  passing  more  or  less  within 
the  orifice,  which  often  appears  to  be  the  part  most 
severely  affected.  The  whole  cervix  is  in  a  state  of 
hypertrophy,  and  considerably  softened,  with  the  excep- 
tion of  the  inflamed  crust  upon  which  the  ulcer  is  situ- 
ated. 

"  Upon  tactile  examination,  the  whole  lower  part  of 
the  uterus  is  found  to  be  altered  in  form :  the  lips  are 
elongated  and  flabby v  and  the  orifice  open.  The  ulcer 
presents  a  flattened,  velvety  surface,  with  a  raised  cord- 
like  external  boundary,  which  the  practiced  touch  will 
be  able  to  detect  without  difficulty.  When  viewed 
through  the  SPECULUM,  the  whole  cervix — unless  it  be 

&  * 

unusually  large — will  readily  fall  within  the  upper 
aperture  of  the  instrument.   The  diseased  surface,  when 


74  HALE    ON    ABOETION. 

both  labia  are  implicated,  appears  irregularly  circular, 
about  the  size  of  a  shilling — larger  or  smaller — of  a 
bright  red  color,  and  covered  over  with  a  coating  of 
muco-pus :  this  being  removed  by  a  piece  of  lint,  to 
which  a  portion  of  ropy  mucus  often  adheres,  derived 
from  the  central  orifice,  the  granulations  are  brought 
palpably  to  view.  The  granulating  ulcer  is 

most  commonly  observed  in  women  of  the  sanguino- 
lymphatic  temperament,  lax  fibre,  and  feeble  circulating 
powers.  When  met  with  in  primapara,  the  first  indi- 
cations of  its  existence  are  noticed  before  the  period  of 
quickening,  often  as  early  as  the  second  or  third  month. 
It  may  exist  for  years,  and  during  several  pregnancies, 
without  causing  abortion."  (See  plate.) 

West*  describes  ulceration  of  the  cervix  in  a  different 
manner : 

"  They  are  for  the  most  part  mere  superficial  abra- 
sions of  the  epithelium  investing  the  lips  of  the  os  uteri, 
whose  abraded  surface  is  of  a  vivid  red  color,  and  finely 
granular.  In  other  cases,  in  which  the  absence  of  epi- 
thelium is  less  complete,  the  surface  seems  beset  by  a 
number  of  minute,  superficial,  aphthous  ulcerations,  be- 
tween which  the  tissue  appears  healthy,  or  slightly 
redder  than  natural.  The  ulcerations  of  the  os  uteri 
seldom  or  never  present  an  excavated  appearance  with 
raised  edges,  as  ulcers  of  other  parts  often  do,  but  either 
their  surface  is  smooth,  or  it  projects  a  little  beyond  the 
surface  of  the  surrounding  tissue.  They  are  usually, 
but  not  constantly,  of  greater  extent  on  the  posterior, 
than  on  the  anterior  lip,  are  sometimes  confined  to  the 
former,  but  very  rarely  indeed  limited  to  the  latter. 
They  appear  to  commence  at  the  inner  margin  of  the 
os  uteri,  whence  they  extend  oufward,  and  sometimes, 
though  by  no  means  invariably,  the  short  extent  of  the 
•  MI in  1  of  the  cervix  uteri  which  can  be  brought  into 
view  by  the  speculum,  appears  denuded  of  its  epithe- 
lium.1' 

*  Diseases  of  "Women,  page  97. 


CAUSES    OF   ABOETION.  75 

Other  writers  vary  as  much  in  their  description  of 
nlceration  of  the  os  and  cervix,  as  Bennet  says,  "  with- 
out necessity  or  advantage." 

Writing  of  this  lesion  the  same  writer  says  : 

"  An  ulceration  occupying  the  cervix  uteri  may  pre- 
sent the  various  modifications  which  suppurating  sur- 
faces offer  in  any  other  part  of  the  body,  from  the 
minute  granulations  of  a  slight  abrasion,  to  the  livid 
vegetations  of  an  unhealthy  sore ;  but  these  modifica- 
tions of  the  ulceration  require,  in  reality,  no  division  or 
classification." 

The  student  who  would  acquaint  himself  with  the 
various  local  and  constitutional  symptoms  caused  by 
these  ulcerations,  may  refer  to  such  works  as  West, 
Meigs,  Scanzoni,  Simpson,  and  particularly  Bennet. 

To  the  Allopathic  school,  who  attack  all  ulcerations 
of  the  cervix  uteri  with  caustics  or  constitutional  reme- 
dies— tonics  and  alteratives — the  division  of  ulceration 
into  different  forms  and  species,  may  be  of-  no  practical 
use  or  benefit ;  but  to  the  homoeopathician,  these  classi- 
fications, or  minute  descriptions,  may  be  of  great  value 
in  the  selection  of  the  specific  remedy,  especially  when 
our  Materia  Medica  shall  be  perfected,  particularly  the 
pathological  symptoms  thereof. 

After  consulting  all  the  more  recent  writers  who  des- 
cribe ulceration  of  the  cervix  uteri,  and  from  the  results 
of  my  own  limited  observation,  I  know  no  better  man- 
ner in  which  to  classify  these  lesions  than  the  one 
adopted  by  Whitehead — namely  : 

Superficial  erosion,  Fissured  ulceration, 

Va/ricose  ulceration,  Follicular  ulceration. 

Bennet  inadvertently  sanctions  this  arrangement,  for 
he  mentions—"  Abrasion,  or  Excoriation  "  — "  Ulcera- 
tion, with  Fungous  Granulations" — and  "  Varicose  con- 


76  HALE   ON   ABORTION. 

dition"  of  the  parts — "  Aphthae,  or  Ulcerated  Mucous 
Follicles" — and  even  a  condition  when  "The  lips  of 
the  os  uteri  are  very  much  hypertrophied  and  indur- 
ated *  *  separated  by  a  deep  fissure,  and  the  ulcer- 
ated surface,  which  is  situated  deeply  between  them,  can 
only  be  discovered  with  the  eye,  on  their  being  sepa- 
rated by  a  bivalve  speculum." 

We  will  now  examine  the  peculiar  characteristics  of 
the  different  forms  of  ulceration  :  the  simple  erosion,  or 
granulating  ulcer,  has  already  been  described. 

Varicose  Ulcer. — This  variety,  .according  to  White- 
head,  is  liable  to  cause  abortion  in  the  latter  two  or 
three  months  of  pregnancy.  It  prevails  in  about  six 
or  eight  cases. out  of  every  hundred,  and  is  often  diffi- 
cult of  cure  before  delivery:  It  is  generally  met  with 
in  women  of  the  bilious  temperament  and  hard  fibre, 
who  have  been  subject  to  piles  and  profuse  menstrual 
discharges,  and  to  derangement  of  the  biliary  organs. 
The  premonitory  condition  of  the  parts  consists  in  a 
hardened  and  hypertrophied  state  of  the  cervix,  which 
is  traversed  in  various  directions  by  a  number  of  tortu- 
ous dark  colored  trunks,  about  the  thickness  of  a  probe, 
or  goose  quill,  raised  upon  the  surrounding  surface. 
Larger  and  more  prominent  points  are  here  and  there 
noticed,  indicating  the  situation  of  inosculation  of  one 
branch  with  another ;  and  generally,  at  one  of  these 
points,  the  ulcerative  process  is  set  np,  which  soon  ex- 
tends through  the  coats  of  the  vessel,  and  haemorrhage 
follows  immediately.  The  ulcer,  which  is  not  long 
after  in  being  developed,  presents  an  uneven  livid  aspect, 
with  irregular  margins,  near  which  a  few  tortuous  ves- 
sels may  be  seen  ramifying:  it  now  secretes  a  quantity 
of  pus,  and  often  has  small  dark  clots  of  blood  or  fibrin, 
the  size  of  a  pin's  head,  lying  loose  upon  the  surface. 


CAUSES    OF   ABOKTION.  V7 

It  usually  occupies  but  one  labium,  the  anterior  more 
frequently,  but  often  the  whole  circumference  of  the 
cervix  is  implicated.  Sometimes  the  inflammation  ex- 
tends to  the  body  of  the  uterus,  as  an  acute  phlebitis, 
and  thus  acquires  a  serious  importance.  The  symptoms 
indicating  the  existence  of  varicose  ulceration  during 
pregnancy,  are  bearing-down  pains  of  an  intermittent 
character,  similar  to  those  of  the  first  stage  of  labor, 
aching  of  the  loins  and  along  the  thighs,  irritable  blad- 
der, with  inability  to  retain  the  urine  the  usual  length 
of  time,  disorded  digestion,  sickness  and  headache,  lan- 
guor, and  a  vaginal  discharge  of  a  white  glairy  mucus 
at  first,  which  becomes  brown,  then  bloody,  and  finally 
purulent.  Bennet  says  this  form  of  ulceration  is  gener- 
ally attended  with  fungous  granulations,  large,  livid, 
and  bleeding  at  the  slightest  touch.  Whitehead  says 
it  causes  induration  of  the  cervix,  and  often  degenerates 
into  the 

Fissured  Ulcei\ — This  form  of  uterine  disease,  ac- 
cording to  Whitehead,  is  perhaps  equally  prevalent 
with  the  superficial  variety,  and  is  much  more  difficult 
of  cure,  on  account  of  the  extent  to  which  the  subjacent 
textures  are  implicated.  It  is  found  to  exist  in  twenty 
to  twenty-four  out  of  every  hundred  cases  of  abortion, 
not  resulting  from  accidental  causes.  It  is  always 
accompanied  by  a  degree  of  inflammatory  induration 
which  extends  more  or  less  deeply  on  each  side  of  the 
fissure ;  this  is  readily  detected  by  the  touch,  the  cir- 
cumference of  the  orifice  being  uneven  and  lobulated. 
There  may  be  one  or  more  fissures,  the  intervening 
spaces  being  healthy  or  inflamed,  excoriated,  and  in  a 
state  of  erosion,  or  superficial  ulceration.  The  fissures 
are  often  deep,  and  extend  to  a  considerable  distance 
in  an  upward  direction. 


78  HALE    ON    ABORTION. 


The  oKsehargt)  which  is  seldom  so  abundant  as  in  the 
form  of  disease  first  described,  has  a  decidedly  purulent 
character,  being  alkalescent,  of  a  yellow  or  greenish 
yellow  color,  sometimes  brown  or  ichorous,  and  not  un- 
frequently  mixed  with  blood.  This  variety  of  ulcera- 
tion  is  considered  the  most  intractable  —  existing  for 
years.  Whitehead  thinks  it  one  of  the  most  frequent 
causes  of  "  habitual  abortion."  Whether  this  accident 
occurs  habitually  at  the  third,  sixth,  or  any  other  period, 
is  owing  to  the  extent  of  the  parts  affected  by  the 
ulceration,  and  Dr.  A.  K.  Gardner*  adopts  this  view, 
and  mentions  many  cases  in  proof.  The  discliarge  be- 
gins to  be  mixed  with  blood  as  soon  as  the  expansion 
of  the  uterus  extends  itself  as  far  as  the  diseased  parts, 
the  slightest  irritation  being  sufficient  to  induce  haem- 
orrhage. The  careful  introduction  of  the  speculum,  or 
digital  examination,  will  cause  bleeding.  Haemorrhage 
from  fissured  ulcer  often  gives  rise  to  the  so-called 
"menstruation  during  pregnancy,"  the  habitual  con- 
gestion during  the  usual  menstrual  period  being  suffi- 
cient to  cause  bleeding  from  the  ulcerated  surface. 
Regarding  this  phenomena,  Dr.  Whitehead  thus  writes: 
"  The  evidence  now  producedf  appears  sufficient  to 
establish,  as  a  general  rule  —  to  which  I  am  not  as  yet 
acquainted  with  an  exception  —  that  the  blood  discharged 
in  cases  of  alleged  menstruation  during  pregnancy  is 
furnished,  not  by  the  lining  membrane  of  the  uterus, 
nor  by  any  healthy  secreting  surfaces  —  except  some- 
times the  inferior  part  of  the  inner  cervix  —  but  by  the 
lower  extremity  of  the  uterus,  external  to  its  cavity,  or 
by  the  contiguous  vaginal  reflexion  being  in  a  state  of 
xHjijmrtitii'?  inflammation.  The  fact  is  always  demon- 
strable by  the  aid  of  the  speculum." 

*  See  cases  in  "Abortion  and  Sterility,"  p.  181. 
f  "  Gardner  on  Sterility.'' 


CAUSES    OF   ABOKTION.  79 

"The  symptoms  indicating  the  presence  of  the  disease 
in  question,  are — severe  aching  of  the  loins  and  sacrum, 
tenesmus,  irritable  bladder,  with  frequent  desire  to  void 
urine,  violent  pain  of  the  lower  part  of  the  abdomen, 
often  confined  to  one  side,  at  a  point  a  little  above  the 
groin,  corresponding  to  the  situation  of  the  round  liga- 
ment, and  following  the  course  of  the  inguineo  cutane- 
ous and  external  pudic  nerves." 

Follicular  Ulceration. — This  form  of  disease  of 
the  cervix  is  said  to  be  an  inflammation  and  ulceration 
of  the  Nabothean  follicles.  It  occasionally  accompa- 
nies other  morbid  conditions  of  the  cervix,  but  is  most 
frequently  met  with  in  a  distinct  form.  Whitehead 
doubts  whether  it  is  a  primary  affection.  Upon  exami- 
nation, the  part  appears  to  be  studded  with  a  number 
of  raised  circular  spots,  having  the  dimensions  of  small 
peas,  covered  with  a  white  crust,  the  surrounding  sur- 
face being  of  a  reddish  hue.  This  white  pellicle  is 
easily  removed  by  means  of  lint,  exposing  a  surface  of 
the  same  form  and  size,  slightly  elevated,  and  appear- 
ing as  if  composed  of  extremely  minute  granules.  The 
parts  are  not  painful  to  the  touch.  These  spots  are 
sometimes  numerous,  as  many  as  fifteen  or  twenty 
being  visible,  but  often  only*  one  or  two  are  seen. 
Owing  probably  to  specific  causes  they  sometimes  be- 
come very  promin%nt,  and  assume  a  warty  appearance. 

According  to  Bennet — who  will  not  admit  of  any 
classification  of  inflammatory  ulceration — this  follicular 
ulceration  is  to  be  considered  the  same  as  any  other 
arising  from  that  cause ;  but  he  admits  that  "  sometimes 
we  find,  in  the  vicinity  of  the  os  uteri,  several  small 
ulcerated  patches,  isolated  one  from  the  other,  but  near 
to  it.  These  multiple  ulcerations,  which  are  rare,  are 

*  See  cases  in  "  Abortion  and  Sterility,"  p.  181. 


80  HALE    ON    ABORTION". 

evidently  formed,  in  the  first  instance,  by  aphtha,  or 
ulcerated  mucous  follicles." 

I  have  under  treatment,  at  the  time  of  this  writing, 
a  case  of  follicular  ulceration  of  the  cervix,  associated 
with  hypertrophy  of  the  uterus,  and  consequent  retro- 
version.  The  patient  had  an  abortion  four  months 
since,  caused  undoubtedly  by  these  conditions.  When 
this  variety  of  ulceration  occurs  in  cachectic  habits, 
or  in  women  advanced  in  life,  these  follicles  are  liable 
to  inflame  and  suppurate  in  considerable  numbers,  leav- 
ing circular  cavities,  which  give  to  the  parts  a  worm- 
eaten  appearance :  or  the  suppurative  action  may  ex- 
tend, until  several  of  the  orifices  coalesce,  forming  a 
deep,  irregular  shaped  excavation,  with  callous,  over- 
hanging margins,  constituting  what  some  writers  have 
described  as  the  "  corroding,  or  phagsedenic  ulcer." 
Induration  and  oadema  of  the  cervix  is  a  common  con- 
comitant of  this  aggravated  form  of  follicular  ulceration. 

Phagcedenic,  Corroding,  Cancerous  Ulceration. — Under 
the  above  names  have  been  described  various  forms  of 
ulceration  of  the  cervix,  of  a  malignant  character,  char- 
acterized by  a  tendency  to  sloughing,  with  extension  of 
ulceration  to  the  body  of  the  uterus,  and  a  discharge, 
nearly  always  of  a  foetid,  corrosive,  and  otherwise  un- 
healthy character.  These  forms  of  laceration  generally 
lead  to  organic  changes,  such  as  hypertrophy,  indura- 
tion, tumors,  etc.,  which  will  be  treated  of  hereafter. 
;  i  Syphilitic  Ulceration. — There  can  be  no  doubt  that 
the  syphilitic  ulcer  is  a  frequent  cause  of  abortion.  It 
was  not  until  recently  that  its  importance  as  such  was 
suspected.  In  treating  the  abandoned  classes  in  gr^at 
cities,  and  even  those  in  higher  positions,  the  physician 
will  do  well  to  be  on  the  look-out  for  this  disease,  when 
he  is  searching  for  the  cause  of  abortion. 


CAUSES    OF    ABOKTION.  81 

The  primary  venereal  sore  is  very  rarely  seen  attack- 
ing the  lower  part  of  the  uterus.  The  virus  is  not 
likely  to  be  carried  up  so  high,  except  in  occasional 
cases.  It  is  chiefly  secondary  syphilis  which  affects  the 
uterus.  It  may  have  its  origin  in  three  different  ways, 
according  to  Whitehead. 

(1)  As  an  imperfectly  cured  primary  affection,  which 
was  originally  a  genuine  chancre  in  the  external  geni- 
tals. 

(2)  As  a  result  of  virulent   inoculation   upon  the 
lower  part  of  the  uterus. 

(3)  As  a  consequence  of  secondary  inoculation.    The 
possibility  of  transference  of  venereal  taint  under  this 
form,  is  still  a  matter  of  dispute. 

The  constitutional  symptoms  denoting  the  presence 
of  secondary  syphilis  are,  pallor  of  the  countenance, 
languor,  precarious  appetite,  loss  of  rest,  hectic  fever- 
ishness,  lumbar  and  hypogastric  pains,  disordered  secre- 
tions, and  the  appearance  of  the  disorder  in  the  off- 
spring. 

The  local  symptoms,  enumerated  in  the  order  of  their 
frequency,  are,  (1)  ^Endo-cervicitis^  or  inflammation  of 
the  lining  membrane  of  the  cervix  uteri,  with  inflam- 
mation, excoriation,  or  ulceration  of  the  labia  around 
the  uterine  orifice.  This  appearance  was  noticed  in  19 
out  of  28  cases. 

(2)  A  mottled  or  patchy  appearance  of  the  cervix, 
consisting  of  a  number  of  dark  red£  spots  of  irregular 
shape,  surrounded  by  lighter  colored  portions :  they 
sometimes  appeared  highly  irritable  and  excoriated, 
but  not  aphthous ;  the  whole  cervix  was  generally  en- 
larged and  slightly  indurated  and  in  most  cases  there 
were  evidences  of  endo-cervicitis. 

(3)  AphtJiGB  of  the  cervix,  occurring  in  8  out  of  28 
6 


82  HALE    ON    ABORTION. 

cases ;  the  patches,  which  appeared  perfectly  white,  of 
a  circular  or  oblong  shape,  situated  upon  a  dark  red 
base,  were  easily  detached  by  the  aid  of  lint,  and  left 
a  bright  red  surface  of  similar  form  and  dimensions, 
having,  in  some  instances,  a  very  minutely  granular 
aspect.  These  were  associated  with  hypertrophy  of 
the  cervix  and  endo-cervicitis. 

(4)  Warts  were  witnessed  in  3  out  of  28  cases,  twice 
on  the  cervix  and  once  on  the  walls  of  the  vagina.  They 
were  witnessed  in  many  other  cases. 

The  syphilitic  ulceration  of  the  cervix  cannot  be 
diagnosed  from  that  of  a  non-venereal  character,  except 
by  an  actual  knowledge  of  the  presence  of  the  specific 
poison  in  the  system  of  the  patient.  There  is  nothing 
in  the  appearance  of  the  ulcer  or  erosion  which  can 
show  itself  to  be  syphilitic.  When  we  see  warts,  or 
the  mottled  appearance  mentioned  by  Whitehead,  we 
may  justly  have  our  suspicions. 

Syphilis  may  act  as  a  predisposing  cause.  (See  that 
chapter.) 


SECTION    VII. 

Induration  of  the  Cervix  Uteri. — This  may  be  a  pri- 
mary or  idiopathic  affection.  Whitehead  met  with 
severe  cases  of  chronic  induration  during  pregnancy,  in 
only  two  of  which  treatment  was  effectual  in  averting 
abortion.  All  these  persons  had  aborted ;  three  of 
them,  including  the  two  just  mentioned,  he  had  at- 
tended in  the  preceding  instances,  in  all  of  which  the 
same  form  of  disease  at  that  time  existed,  and  in  the 


CAUSES    OP    ABOETION.  83 

remaining  four,  it  is  probable,  had  long  before  existed. 
The  sum  of  their  abortions  was  19  ;  the  average  age  of 
the  patients  31  years. 

This  form  of  disease  is  usually  met  with  as  a  chronic 
affection,  the  result  of  previous  deep-seated  inflamma- 
tion, a  species  of  prolonged  naetritis.  The  enlargement 
and  induration  may  involve  the  whole  neck,  or  may  be 
confined  to  the  anterior  or  posterior  lip  alone.  In 
either  case  it  may  depend  on  inflammatory  action,  or 
upon  some  general  cachexia.  In  the  latter  case  the  in- 
duration may  be  accompanied  with  hypertrophy  due 
to  fibrinous  deposit,  or  infiltration  of  serum  into  the 
tissue  of  the  cervix.  The  last  named  condition  is 
termed  cedema  of  the  cervix.  On  examination,  one  or 
both  labia  of  the  cervix  will  present  the  appearance  of 
a  hard  conical  substance,  sufficiently  large,  generally, 
to  occupy  the  whole  orifice  of  an  average-sized  glass 
speculum.  If  the  anterior  lip  alone  is  affected,  the  os 
is  situated  behind,  and  high  up,  and  is  Avith  difficulty 
brought  into  view.  "  When  both  labia  are  diseased 
they  present  a  neutral  appearance,  very  much  resemb- 
ling the  top  of  the  piece  representing  the  bishop,  in 
games  of  chess."  Their  opposing  surfaces  are  often 
inflamed,  excoriated  or  granular,  and  the  fissures  at 
their  base  ulcerated,  and  exuding  pus. 

This  form  of  disease  usually  occasions  abortion  be- 
fore the  fifth  month,  although  it  may  occur  consider- 
ably later. 

The  symptoms  of  induration,  hypertrophy,  or  cedema,, 
are  quite  characteristic.  A  painful  sense  of  constriction 
around  the  pelvis  and  hips  is  almost  constantly  present ; 
a  dull,  fixed,  aching  pain  of  one  or  both  ovarian  regions, 
irritability  of  the  bladder  and  rectum,  pain  in  the  re- 
gion of  the  sciatic  nerves,  a  highly  excited  state  of  the 


84  HALE   ON   ABORTION. 

whole  nervous  system,  lassitude,  indigestion,  etc.  Ha- 
bitual abortion  may  be  the  result  of  this  diseased  con- 
dition of  the  cervix. 


Displacements  of  the  Uterus. 

The  various  malpositions  of  the  womb  may  act  as 
causes  of  abortion. 

Anteversion,  although  of  rare  occurrence,  may  so 
irritate  the  bladder  as  to  set  up  sufficient  reflex  action 
to  result  in  expulsion  of  the  ovum. 

Prolapsus  is  a  more  frequent  cause  of  abortion. 
This  displacement  generally  occurs  previous  to  preg- 
nancy, as  a  result  of  congestion  of  the  uterus,  or  indu- 
ration, with  hypertrophy  of  the  cervix,  and  often  from 
mere  muscular  atony.  In  either  case  the  uterus  will 
be  found,  on  examination,  low  down  in  the  vagina,  the 
lips  of  the  cervix  resting  on  the  perineal  floor,  and  the 
body  of  the  fundus  within  easy  reach  with  the  finger. 

Until  the  end  of  the  third  month  this  condition  is 
not  generally  provocative  of  any  tendency  to  abortion, 
but  about  this  time  the  uterus  increases  in  size,  and 
unless  it  rises  above  the  promontory  of  the  sacrum  it 
becomes  impacted  in  the  pelvis.  Any  impediment  to 
the  proper  expansion  of  the  uterus  will  prove  an  excit- 
ing cause  of  abortion.  In  prolapsus  and  retroversion 
this  impediment  exists,  unless  the  uterus  rises  out  of 
the  pelvic  cavity. 

Retroversion. — This  is  the  most  formidable  displace- 
ment to  which  the  gravid  uterus  is  liable,  and  one 
which  is  more  likely  to  cause  abortion  than  any  other. 
Retroversion  during  pregnancy  was  first  fully  described 
by  William  Hunter,  and  Denman.  This  affection 
occurs  in  its  most  decided  form  at  about  the  third  or 


CAUSES   OF   ABORTION.  85 

fourth  month,  when  the  uterus  is  entirely  within  the 
pelvis,  and  when  it  is  of  such  large  size  that  any  alter- 
ation from  its  natural  position  occasions  great  incon- 
venience to  the  neighboring  organs. 

Retroversion  during  pregnancy  may  be  sudd&ri  in  its 
occurrence  ;  or  it  may  have  existed  from  the  period  of 
conception.  In  the  former  case  it  may  be  caused  by 
unusual  exertions,  as  lifting,  jumping,  reaching;  or 
from  such  accidents  as  falling,  jolting ;  or  from  diseases 
in  which  tenesmus  occurs,  as  dysentery,  etc. ;  also  from 
distension  of  the  bladder.  In  the  latter  case  the  retro- 
version  had  either  existed  previous  to  conception,  or 
occurred  during  the  first  weeks  of  gestation.  For  a  full 
description  of  the  symptoms  and  causes  of  these  dis- 
placements the  reader  is  referred  to  my  Monograph  on 
that  subject.* 

Retroversion  occurring  during  pregnancy  is  usually 
described  as  arising  from  excessive  distension  of  the 
bladder,  through  neglect,  reserve,  or  restraint  on  the 
part  of  the  patient.  It  is  believed  that  the  full  blad- 
der, rising  in  the  abdomen,  drags  the  neck  of  the  uterus 
upwards,  while  the  distended  organ  presses  the  fundus 
uteri  backward.  The  displaced  uterus,  by  the  pressure 
it  exerts  upon  the  neck  of  the  bladder,  in  turn  increases 
the  distension  of  this  viscus,  and  the  retro  verted  uterus 
at  length  becomes  fixed  across  the  pelvis,  the  fundus 
lying  in  the  hollow  of  the  sacrum,  and  the  os  being  tilted 
against  the  pubes,  so  as,  in  the  worst  cases,  to  render 
the  evacuation  of  the  rectum  difficult,  and  that  of  the 
bladder  impossible.  Recent  retro  version  may  undoubt. 
edly  be  caused  in  this  manner ;  but  there  are  doubtless 
many  cases  in  which  retroversion  has  existed  previous 
to  pregnancy,  and  no  inconvenience  is  felt  from  it  until 

*  "  Retroflexion  and  Retroversion  of  the  Uterus." 


ITALE    ON    ABORTION. 


such  time  as  the  uterus,  from  its  size,  presses  upon  the 
bladder  and  rectum  to  such  a  degree  that  the  displace- 
ment is  looked  upon  as  sudden.  In  both  cases  abortion 
may  occur  from  the  irritation  set  up  in  the  surrounding 
organs,  and  in  the  uterus  itself,  or  from  the  utter  impos- 
sibility of  any  further  enlargement  of  the  uterus. 

The  symptoms  of  retroversion,  when  the  uterus  is  of 
such  dimensions  as  to  exert  mechanical  pressure  upon 
the  antero-posterior  axis  of  the  pelvis,  are,  in  the  first 
instance,  partial  or  complete  retention  of  the  urine, 
pain  in  the  pelvic  region,  and  a  sense  of  pressure  on 
the  rectum,  giving  rise  to  a  constant  desire  for  defe- 
cation, even  when  the  bowels  are  empty.  Should  these 
symptoms  pass  unrelieved,  the  bladder  becomes  some- 
times enormously  distended,  and  even  ruptured  me- 
chanically, or  the  coats  inflame  and  ulcerate,  allowing 
the  urine  to  escape  into  the  peritoneal  cavity,  and 
the  patient  sinks  or  dies  of  peritonitis.  If  the  uterus 
cannot  be  replaced,  and  the  water  is  occasionally  and 
with  difficulty  drawn  off,  the  bladder  gradually  enlarges 
and  elongates,  and  its  mucous  membrane  becomes  dis- 
eased ;  muco-purulent,  ammoniacal  and  bloody  urine  is 
passed,  and  the  kidneys  may  become  diseased  by  the 
effects  of  the  backward  pressure  of  the  urine.  The 
structures  between  the  bladder  and  the  uterus  may 
become  inflamed,  and  the  patient  be  destroyed  by  irri- 
tative fever.  In  some  cases  all  these  mischiefs  are 
arrested  or  modified  by  spontaneous  abortion.  In  others 
the  displacement  continues  to  the  fifth  or  sixth  month, 
without  destroying  the  patient,  and  it  has  been  known 
to  go  on  to  the  full  term  without  causing  a  fatal  result. 
These  cases  are  however  very  rare,  and  the  occurrence 
of  abortion  is  less  to  be  dreaded,  than  a  continuance 
of  the  displacement,  j 


CAUSES    OF    ABORTION.  87 

Death  of  Embryo,  from  any  cause,  will  result  in  an 
abortion.  The  presence  of  a  foreign  body  in  the  ute- 
rus will,  in  the  majority  of  cases,  cause  the  uterus  to 
exert  its  expulsive  action.  There  are,  however,  many 
cases  in  which  the  foetus  and  its  envelopes  have  passed 
off  in  a  fluid,  disorganized  state ;  and  cases  are  on  record 
even  where  the  embryo  after  its  death  was  undoubt- 
edly absorbed.  In  another  class  of  cases,  the  dead 
embryo  itself,  or  the  placenta,  is  left  to  become  a  mole 
or  hydatid  mass. 

Coitus,  when  indulged  in  to  excess,  or  even  its  mod- 
erate indulgence  in  women  whose  reproductive  organs 
are  irritable  from  disease,  may  be  a  cause  of  abortion. 
This  may  occur  at  any  period  of  pregnancy,  but  espe- 
cially at  or  about  the  usual  menstrual  periods.  Coition 
causes  abortion  by  exciting,  from  the  mechanical  irrita- 
tion it  induces,  the  reflex  influences  which  preside  over 
the  uterus.  If  the  os  or  cervix  is  diseased,  the  irrita- 
tion excites  the  peristaltic  action  of  the  uterus ;  if  not, 
it  is  probably  the  diastaltic  action  which  is  aroused. 

Many  cases  of  habitual  abortion  will  be  found  to  be 
due  to  this  cause  alone,  and  if  abstinence  from  inter- 
course be  strictly  enforced,  either  wholly  or  at  the  men- 
strual periods,  the  usual  abortions  will  be  prevented. 

As  a  rule,  sexual  intercourse  should  not  be  indulged 
in  at  all,  or  very  rarely,  during  the  period  of  pregnancy. 
That  it  is  physiologically  unnatural  every  physician 
will  admit.  The  general  aversion  to  the  act  manifested 
by  women  during  that  period,  as  also  the  fact  that  the 
animal  creation  rarely,  if  ever,  cohabit  during  gestation, 
should  teach  us  that  it  is  improper.  Whether  sexual 
connection  should  be  prohibited  or  not,  will  depend 
upon  the  judgment  of  the  physician. 


88  HALE    ON    ABORTION. 

Instrumental  Irritation. — The  use  of  instruments, 
whether  for  criminal  or  surgical  purposes,  is  a  very 
frequent  and  powerful  cause  of  abortion  at  any  stage 
of  pregnancy.  Criminal  abortion  is  rarely  brought 
about  by  the  administration  of  drugs ;  it  is  generally 
induced  by  some  instrument  which  has  for  its  object 
the  puncturing  or  separation  of  the  membranes,  the 
death  of  the  ftetus,  or  the  irritation  of  the  os  uteri,  by 
which  means  the  uterus  is  made  to  expel  the  product 
of  conception  prematurely.  The  same  may  be  said 
when  abortion  or  premature  labor  is  induced  by  the 
physician,  in  a  legitimate  manner — i.  e.  to  insure  the 
safety  of  the  mother  or  child,  or  both.  Instruments 
have  sometimes  to  be  used  during  pregnancy,  for  pur- 
poses foreign  to  the  accident  above  named,  such  as 
replacing  a  retroverted  uterus,  or  in  cases  of  extreme 
prolapsus,  although  such  instances  are  rare.  But  there 
are  cases  on  record  where  a  retroverted  uterus  became 
so  impacted  that,  other  means  failing,  it  was  considered 
justifiable  and  necessary  to  use  the  uterine  sound.  In 
such  cases  it  would  seem  that  abortion  would  be  the 
inevitable  result ;  but  I  believe  the  operation  might  be 
performed  in  the  early  months,  and  the  foetus  and 
membranes  remain  intact.  My  opinion  is  based  on 
several  instances  which  have  come  under  my  own 
observation,  where  a  sound  was  introduced  into  the 
uterine  cavity,  and  turned  several  times  round,  with  no 
other  effect  than  slight  pain  and  haemorrhage — preg- 
nancy not  being  interrupted,  but  terminating  naturally. 

Pessaries  have  been  introduced  for  the  purpose  of 
supporting  a  prolapsed  uterus  during  pregnancy.  The 
presence  of  such  a  foreign  body  in  the  vagina,  may,  by 
exciting  the  reflex  action,  cause  an  expulsion  of  the 
ovum ;  yet  pessaries  have  been  worn  for  several 


CAUSES    OF   ABOETION.  89 

months   by  pregnant  women,  without   such  a  result. 

As  a  general  rule,  the  use  of  all  instruments,  intro- 
duced into  the  uterus  or  vagina,  should  be  dispensed 
with,  if  possible,  during  utero-gestation,  as  well  as  all 
surgical  operations  on  these  organs,  or  on  contiguous 
organs  or  tissues.  Instances  are  not  wanting,  however, 
where  women  have  borne  the  most  severe  operations, 
even  on  neighboring  organs,  without  interfering  with 
the  normal  advance  of  pregnancy. 

Dr.  Whitehead  gives  the  treatment,  by  caustics,  of 
several  cases  of  ulceration  of  the  os,  during  pregnancy, 
which  treatment  was  successful,  not  only  in  curing  the 
diseased  condition,  but  of  preventing  an  habitual  abor- 
tion due  to  the  ulceration. 

No  positive  rule  can  be  laid  down  as  regards  the  use 
of  such  remedial  measures,  as  the  irritability  of  the 
uterus  varies  greatly  in  different  individuals. 

Ovarian.  —  The  functional  disorders  which  may 
prove  exciting  causes  of  abortion  are  simple  irritation, 
from  perverted  physiological  influences :  Congestion 
and  Inflammation. 

During  pregnancy,  the  ovaries  should  be  in  a  dor- 
mant condition.  Their  functional  activity  is  supposed 
to  be  suspended,  because  there  is  no  use  for  the  ovum, 
even  if  it  were  formed  and  extruded.  In  some  instances 
the  process  of  ovulation  may  go  on  during  pregnancy, 
at  the  usual  menstrual  periods.  We  know  the  same 
process  does  often  occur  during  lactation ;  but  it  is 
believed  that  in  both  cases  it  is  an  unnatural  proceed- 
ing, and  that  it  arises  from  some  abnormal  irritation  of 
the  ovaries.  When  this  process  occurs  during  preg- 
nancy, the  consequent  afflux  of  blood,  or  nervous  force, 
to  the  uterus,  is  often  quite  sufficient  to  induce  abortion. 
We  believe  that  this  is  the  chief  cause  of  that  form  of 


90  HALE    ON    ABORTION. 

habitual  abortion,  which  occurs  within  four  weeks  after 
conception,  but  about  which  so  little  has  been  written 
or  known. 

Congestion  and  inflammation  of  the  ovaries  may 
cause  abortion  by  the  severe  reflex  irritation  which  the 
diseased  process  originates.  The  organic  diseases  liable 
to  cause  abortion  are,  ovarian  tumors,  dropsy  and  cystic 
enlargement. 


SECTION    VIII. 

MEDICINAL    CAUSES    OF   ABOETION. 

A  list  of  the  medicines  which  have  been  known  to 
cause  abortion  at  various  periods  of  pregnancy ;  toge- 
ther with  others  which  have  been  supposed  to  be  detri- 
mental to  the  life  of  the  fcetus,  has  been  given  on  a 
previous  page  of  this  work. 

In  order  that  we  may  arrive  at  some  definite  conclu- 
sion as  to  the  real  influence  of  the  drugs  named,  it  will 
be  proper  for  us  to  consider  them  separately. 

It  is  manifestly  impossible  for  us  to  classify  the  medi- 
cinal causes,  as  we  have  classified  other  morbific  influ- 
ences, for  in  the  present  stage  of  our  knowledge  of  the 
pathological  action  of  medicines,  we  cannot  decide  with 
absolute  certainty  whether  secale  or  cimicifuga^  etc., 
cause  abortion  by  their  action  on  the  spinal  cord  (cen- 
tric), or  upon  the  uterus  directly  (concentric).  We 
cannot  decide  whether  a  medicine  causes  diastaltic  or 
peristaltic  action  chiefly ;  nor  cajj  we  say  positively  that 
aloes  induces  abortion  by  irritation  of  the  rectum  alone, 
or  terebinth  by  its  action  upon  the  urinary  organs. 


CAUSES    OF   ABORTION.  91 

But  as  all  methods  of  classification  must  have  a 
beginning,  the  following  classes  may  be  made,  and  their 
imperfections  rectified  at  some  future  day,  when  greater 
pathogenetic  or  pathological  progress  shall  have  been 
made  in  our  school. 

Medicines  whwh  act  as  PREDISPONENT  causes.  — 
Belladonna,  calcarea  carb.,  carlo  veg.,  china,  chamo- 
milla,  clienopodium,  ferrum,  hyosciamus,  lacliesis,  lyco- 
podium,  mercury,  nux  vomica,  platinum,  podophyllum, 
pulsatilla,  plumbum,  sepia,  silicea,  sulphur,  zinc,  and 
many  others,  which  have  the  power  of  causing  a  dys- 
crasia  in  the  system,  or  a  cachectic  state  of  the  body. 

Medicines  which  act  as  CENTRIC  causes. — Secale  corn., 
cimicifuga,  caulophyllum,  gelseminum,  quinine,  cannabia 
ind.,  nux  vomica,  ignatia,  strychnia,  are  the  principal 
medicinal  agents  at  present  known  to  the  profession. 

Medicines  which  act  as  CONCENTRIC  causes. — All,  or 
nearly  all  the  medicines  in  the  list  may  act  in  this  man- 
ner ;  but  upon  various  organs,  and  thence  to  the  uterus 
by  reflex  action.  Thus,  aloes,  podophyllum,  mercury, 
and  others  are  said  to  act  on  the  rectum;  cantJiaris, 
cannabis  sat.,  turpentine,  sabina  (f)  upon  the  urinary 
organs ;  and  apis  mel.  upon  the  ovaries. 

A  medicine  may  act,  however,  both  as  a  reflex  and 
concentric  cause  of  abortion  at  the  same  time. 

Special  analysis  of  the  principal  medicinal  agents 
capable  of  causing  abortion  : 

Apis  mellifica. 

-L  </ 

This  poison  is  stated  to  have  produced  "  miscarriages 
in  the  second,  third,  and  fourth  months."  Dr.  Humph- 
reys asserts,  that  he  has  in  several  instances  known  it 
to  produce  miscarriages  when  given  for  various  maladies 


92  HALE   ON   ABOKTION. 

during  pregnancy.  This  is  said  to  be  corroborated  by 
other  physicians.  I  have,  however,  known  it  to  be 
administered  with  this  intent  by  several  physicians,  but 
with  no  such  result  as  above  stated ;  and  upon  wide  in- 
quiry. I  cannot  obtain  any  reliable  testimony  relating 
to  its  oxytoxic  powers.  That  abortion  may  occur  while 
the  patient  was  suffering  from  the  poisonous  effects  of 
bee-stings,  I  do  not  doubt ;  but  I  beg  leave  to  be  sceptical 
as  to  the  power  of  the  3rd  and  6th  dilutions,  or  even 
the  1st  trituration,  in  causing  that  accident.  If  apis 
causes  abortion  when  taken  internally,  it  probably  does 
so  by  its  irritant  action  on  the  ovaries. 

Actcea  alba. 

This  is  a  near  analogue  of  the  actoea  racemosa  (Cim- 
icifuga).  It  is  called  "  white  cohosh,"  in  contradistinc- 
tion to  the  latter,  which  is  known  as  the  "black  cohosh." 
The  country  people  allege  that  it  causes  abortion  in  the 
early  months,  and  physicians  have  used  it  with  success 
in  suppressed  menstruation. 

Aloes. 

The  action  of  aloes,  when  given  in  large  doses,  in 
cases  of  amenorrhoea,  is  well  known  to  every  physician. 
It  increases  the  menses,  causes  menorrhagia,  congestion 
of  the  uterus,  and  abortion.  This  it  is  supposed  to  do, 
by  causing  an  abnormal  engorgement  of  the  blood-ves- 
sels of  the  pelvic  viscera.  If  it  causes  abortion,  there 
is  much  coincident  .irritation  of  the  rectum,  tenesmus, 
haemorrhoids,  dysenteric  symptoms,  etc. 

Asarum. 

Asarum  Ewropeum. — As  early  as  the  sixteenth  cen- 
tury its  abortion-power  was  spoken  of  by  Hieronymus 


CAUSES   OF   ABORTION.  93 

Trajus.  According  to  Berchtold,  it  is  regarded  in 
Bohemia  as  one  of  the  most  active  and  popular  abortion- 
remedies.  Dierbach  places  it  with  sabina,  among  the 
uterine  remedies.  It  is  used  in  England  to  cause  mis- 
carriage, and  Hoffman  cautions  women  who  are  preg- 
nant, against  its  use.  It  seems  to  be  an  analogue  of 
puhatilla;  an  acrid,  emetic,  purgative  medicine,  irritat- 
ing all  the  mucous  surfaces. 

Asarum  Canadense. — This  is  a  plant  indigenous  to 
the  United  States,  known  as  "  wild  ginger,"  etc.  Dr; 
Scudder  says  he  was  informed  many  years  since  that 
the  root  was  used  by  the  Indians  as  a  "  parturient,  and 
also  as  an  abortive."  It  was  said  to  be  used  frequently 
by  white  women  to  prevent  conception,  and  also  to 
cause  abortion.  From  these  reports  Scudder  was  in- 
duced to  try  it  in  amenorrhoaa.  In  his  hands  it  has 
acted  well  in  restoring  the  menses. 

Asclepias. 

The  Asdepias  Incarnata,  was  noticed  in  the  North 
American  Journal  of  Homoeopathy,  by  Dr.  Fowler,  as 
being  capable  of  causing  abortion  in  small  doses — viz., 
two  or  three  drops  twice  a  day ;  but  the  experiments  of 
Dr.  A.  C.  Jones,  of  Philadelphia,  together  with  my  own, 
entirely  disprove  this  statement. 

The  Asclepias  Syriaca,  appears  to  possess  a  decided 
action  upon  the  uterus,  as  its  effects  when  given  in  large 
.  doses  in  a  case  of  dropsy,  reported  in  "  New  Homoeo- 
pathic Provings,"  page  63,  seem  to  prove. 

Aletris  farinosa. 

This  plant  is  said  to  have  caused  abortion  with  ver-    • 
tigo,  headache,  vomiting,  and  narcotic  effects.   Popular 
testimony  ascribes  to  it  the  power  of  causing  abortion 


94  HALE   ON    ABORTION. 

in  the  early  months;  but  we  have  no  positive  medical 
testimony  to  that  effect.  Professor  Tully  says  very 
truly,  that  certain  medicines  are  in  successful  use  by 
the  people  for  the  induction  of  abortion,  long  before 
such  uses  become  known  and  recognised  by  the  medical 
profession. 

Baptisia  tinctoria. 

This  very  depressing  drug  has  been  known  to  cause 
abortion.  A  strong  decoction  of  the  root,  taken  warm, 
at  about  the  period  of  the  menses,  will  produce  such 
extreme  relaxation  as  to  result  in  miscarriage.  Dr.  Coe 
says,  '"  It  should  not  be  used  during  the  period  of  utero- 
gestation,  as  it  is  capable  of  producing  abortion,  for 
which  purpose  we  have  known  it  to  be  used  by  quacks 
and  empirics.  The  danger  to  the  general  health  is 
very  great,  when  used  in  sufficient  quantities  to  produce 
this  result." 

Borax. 

This  is  a  very  ancient  drug ;  known  by  the  older 
physicians  to  be  an  "  ecbolic"  or  producer  of  abortion, 
as  well  as  capable  of  stimulating  the  inert  uterus  in 
cases  of  lingering  labor.  For  the  latter  effect  Kopp 
advises  four  to  six  grains  every  fifteen  minutes,  and  says 
"  it  will  arouse  the  expulsive  action  of  the  uterus,  and 
terminate  the  delivery."  Sunderlin  testifies  from  his 
personal  experience  that  it  is  useful  in  "  difficult  and 
irregular  labors."  Dr.  Grolding  Bird  says,  "In  women, 
this  drug  cannot  be  used  with  impunity,  as  it  certainly 
exerts  a  stimulant  action  on  the  uterus,  and  I  have  seen 
it,  in  two  instances,  pivduce  abortion"  Premature 
labor  has  been  caused  by  borax,  30  grains,  three  times 


CAUSES   OF    ABORTION.  95 

a  day,  for  16  days.     The  labor  was   natural,  and  the 
child  born  alive. 

"  In  doses  of  10  grains,  repeated  three  or  four  times 
a  day,  it  has  produced  abortion,  attended  with  pains 
all  over  the  system,  and  excessive  debility  of  the  joints, 
which  remained  for  several  months,  in  a  greater  or  less 
degree.  v  On  this  account  its  administration  to  pregnant 
females  is  improper."* 

Bovista. 

This  fungus  is  placed  by  Prof.  Tally,  in  his  class 
eclolica,  upon  the  authority  of  "  a  distinguished  phy- 
sician," (name  not  given)  who  "  informed  him  that  if 
collected  before  the  interior  became  a  powder,  it  was 
both  a  narcotic  and  ecbolic. 

Hartlaub  and  Trinks  give  us  a  proving  of  bovista, 
which  would  seem  to  substantiate  the  above  statement. 
It  certainly  has  some  specific  action  on  the  genital 
organs.  We  find  some  notable  symptoms  in  the  patho- 
genesis,  among  which  are,  "  menses  too  early  by  eight 
or  nine  days,  and  more  profuse  /  discharge  of  blood 
between  the  catamenia  ;  bearing-down  towards  the  sex- 
ual organs ;  leucorrhoea,  etc." 

It  seems  that  this  remedy  has  been  too  much  neg- 
lected by  our  profession;  or  those  who  have  tried  it 
may  have  been  disappointed  in  it.  This  may  arise 
from  the  fungus  from  which  the  preparation  was  made 
having  been  collected  when  too  late.  We  are  told  that 
the  smoke  or  odor  of  the  dry  powder  will  act  as  an 
anaesthetic  when  inhaled ;  but  the  ecbolic  property  may 
exist  solely  in  the  green  or  ripe  fungus,  before  it  changes 
to  a  powder.  Jahr's  Pharmacopeia  directs  it  to  be  col- 

*  King's  Obstetrics,  p.  714. 


96  HALE   ON   ABORTION. 

lected  in  the  months  of  August  and  September.  This 
is  too  indefinite.  Experiments  should  be  instituted  to 
test  its  properties,  and  the  most  eligible  method  of 
preparation. 

Cantharides. 

This  violent  poison  has  been  used  for  the  criminal 
purpose  of  producing  abortion,  although  its  action  on 
the  uterus  is  uncertain  and  indirect.  In  cases  where 
this  effect  has  been  produced,  it  was  accompanied  by 
intense  inflammation  of  the  urinary  organs,  swelling 
and  heat  of  the  generative  organs,  and  violent  general 
disturbance  of  the  system.  It  has  caused  abortion 
when  given  to  animals. 

In  the  pathogenesis  of  Hartlaub  and  Trinks,  it  is  said 
to  "  promote  fecundity,  expel  moles,  dead  foetuses  and 
the  placenta  " — a  rather  sweeping  declaration,  and  one 
quite  unwarranted  by  the  facts.  A  poison  so  uncertain ' 
in  its  action  cannot  be  used  with  any  advantage,  in 
large  or  small  doses,  in  such  cases. 

No  more  power  as  an  "  abortivant "  can  be  claimed 
for  cantharides,  than  for  any  of  its  analogues — <7/>/X 
cannabis,  erigeron,  copavia  and  turpentine — except  that 
it  is  the  most  powerful  irritant.  In  fact  turpentine  seems 
more  capable  of  earning  abortion  than  any  other.  The 
cannabis  indica  is  lately  being  used  as  a  partus-accele- 
ratur,  and  in  persons  predisposed  to  abortion,  might 
excite  that  accident,  as  might  any  medicine,  in  large 
doses,  which  specifically  affects  the  uterus. 

Caulophyttum. 

This  medicine  has  a  peculiarly  specific  action  on 
muscular  tissue  generally,  and  that  of  the  uterus  in 
particular.  While  secale  causes  spasmodic 


CAUSES    OF    ABORTION.  97 

action,  this  drug  seems  to  originate  or  call  up  the  peri- 
staltic motion  of  the  uterus.  It  has  been  used  since 
the  settlement  of  this  country,  by  the  whites,  and  by 
the  aborigines  before  them,  as  a  partus-acceleratur. 
In  very  large  quantities  it  has  caused  abortion,  with 
strong  expulsive  efforts,  but  with  no  alarming  or 
disagreeable  symptoms  of  the  general  organism.  But 
it  requires  such  an  inordinately  large  quantity  of  this 
agent  to  effect  miscarriage,  that  it  is  not  often  used 
for  that  purpose.  I  have  known  one  ounce  of  the 
tincture  taken  with  no  apparent  effect,  and  a  pint  of 
strong  decoction  with  like  result.  In  fact,  it  often 
acts  just  the  opposite  of  what  is  desired.  I  have 
known  it  resorted  to  by  women,  and  even  physicians, 
to  hasten  an  impending  abortion,  with  no  other  effect 
than  to  dissipate  the  pains,  and  other  symptoms,  and 
arresting  the  abnormal  process.  In  these  instances, 
one  drachm  doses  of  the  tincture,  and  one  grain  doses  of 
the  alkaloid,  were  repeated  every  hour.  The  same  may 
be  said  of  many  medicines  of  this  class — aletris  far., 
asclepias  syr.,  cimicifuga, — they  prevent  abortion,  even 
in  massive  doses.  This  should  teach  us,  that  although 
minute  closes  may  suffice,  we  should  not  be  afraid  to 
resort  to  material  doses,  when  sanctioned  by  clinical 
experience. 

Cimicifuga  racemosa. 

That  this  powerful  medicine  will  cause  abortion  at 
nearly  all  periods  of  pregnancy,  the  abundance  of  tes- 
timony, in  and  out  of  the  profession,  does  not  leave  us 
in  doubt.  We  do  not  mean  by  this  to  imply  that  the 
black-coliosh  will  invariably  cause  expulsion  of  the  foetus, 
for,  like  all  other  ecbolic  remedies,  it  requires  a  consti- 
tution susceptible  to  its  influence,  in  order  to  have  its 


98  HALE    ON    ABORTION. 

action  developed.  In  the  old  American  "Herbals"  we 
are  told  that  this  root  was  used  by  the  Indians  to  facil- 
itate labor,  and  also  by  their  women  to  produce  miscar- 
riage. Prof.  Tully,  one  of  the  most  extensive  observers, 
has  known  it  to  produce  abortion,  and  had  great  confi- 
dence in  its  power  as  a  partus-acceleratnr.  He  thinks 
all  the  actcece  possess  the  same  power. 

Since  the  publication  of  the  work  on  New  Itemed  it*, 
I  have  received  several  letters  from  correspondents, 
good  medical  observers,  who  assert  that  they  know  the 
decoction  of  the  roots,  or  the  active  principle  (macrotin^ 
will,  in  doses  of  four  or  six  grains,  cause  abortion  in 
some  women,  at  any  period  of  gestation.  I  have  been 
cognizant  of  several  instances  in  which  women  have 
induced  miscarriage  with  the  root,  and  also  where 
physicians  had  administered  the  macrotin  with  that 
result. 

The  symptoms  accompanying  abortion  caused  by 
cimicifuga,  are  generally  these  :  severe  headache,  as  if 
the  top  of  the  head  would  be  pushed  oif,  or  the  eyes 
pressed  out ;  stiffness  of  the  whole  body,  with  torpor, 
heaviness,  and  stiffness  of  the  extremities,  intermitting 
labor-like  pains  in  the  uterus,  with  pain  in  back  and 
thighs,  coldness  and  shivering,  palpitation  of  the  heart, 
neuralgic  pains  in  limbs,  contractions  of  the  tendons, 
lowness  of  spirits. 

If  enormous  doses  are  given,  convulsions  and  serious 
injury  to  the  system  might  ensue,  as  the  remedy  acts 
specifically  on  the  spinal  cord  and  brain  ;  yet  I  cannot 
find  any  record  of  the  drug  having  proved  fatal. 

The  extensive  experience  which  is  being  gained  by 
our  school,  in  the  use  of  this  remedy,  proves  that  it  is 
of  great  value  in  the  treatment  of  many  of  the  diseases 
of  women,  especially  those  occurring  during  the  partu- 


CAUSES.  OF    ABORTION.  99 

rient  state.  It  relieves  the  many  pains  and  disagreeable 
sensations  felt  during  gestation,  prevents  miscarriage, 
conducts  accidental  abortion  safely,  if  inevitable ;  and 
it  also  controls  false  pains  in  the  latter  months,  and 
facilitates  labor,  if  tedious  and  unnatural. 

Decodon  verticittatm. 

This  plant,  known  to  botanists  as  lyihrum  verticilla- 
tum,  and  by  the  common  people  as  swamp  loosestrife, 
or  swamp-willow-herb,  has  the  reputation  of  causing 
abortion  in  brute  animals. 

"If  a  great  amount  of  testimony,"  says  Tully,*  "will 
decide  anything  in  medicine,  decodon  is  ecbolic  for 
certain  brute  animals.  This  effect  is  said  to  be  most 
frequently  produced  upon  ewes,-  next  upon  cows,  and 
sometimes  upon  mares.  Any  amount  of  testimony  to 
this  effect  may  be  obtained  from  intelligent  farmers, 
and  even  much  from  well  educated  physicians,  who  are 
either  farmers  themselves,  or  whose  practice  is  in  an 
agricultural  region  and  almost  wholly  among  farmers." 

T nlly  thinks  if  this  plant  can  cause  abortion  upon 
brute  animals,  it  may  produce  the  same  effect  upon 
women.  Yet  he  is  not  aware  that  it  has  been  verified. 
He  instituted  some  experiments  with  it  on  the  cat  and 
dog,  but  with  no  definite  result.  He  quotes  Lindlay, 
who  says  "  it  is  said  to  destroy  the  young  of  cattle 
heavy  with  calf." 

Kingf  says  "it  is  said  to  cause  abortion  in  mares 
and  cows  browsing  it  in  winter,  and  may,  perhaps,  exert 
a  medicinal  influence  on  the  female  uterus  "  (uterus  of 
women). 

Culpepper  (an  old  English  writer)  says  it  will  "stay 
profuse  courses  in  women." 

*  Materia  Medica,  Vol.  2,  page  1369.         f  Dispensatory. 


100  HALE    ON    ABORTION. 

The  decodvn  may  prove  a  valuable  remedy  when  its 
powers  are  investigated  and  better  known. 

Gossipium  Herlaceum. 

I  know  of  no  agent  used  in  medicine  about  which 
there  is  so  much  variance  of  opinion,  as  to  its  action  on 
the  uterus  especially,  as  the  cotton  root.  In  my  work 
on  New  Remedies*  will  be  found  the  statements  of  Dr. 
Bouchelle,  of  New  Orleans,  and  Dr.  I.  H.  Shaw,  of  Ten- 
nessee, both  of  whom  write  enthusiastically  of  its  powers 
as  a  uterine-motor  stimulant,  and  mention  as  reliable, 
statements  of  its  capabilities  in  causing  abortion.  Dr. 
King  merely  sums  up  the  statements  of  other  writers 
as  to  its  alleged  virtue,  bat  gives  no  experience  of  his 
own.  Dr.  Coe's  statements  are  of  less  value.  Drs.  Jones 
and  Scudder  believe  it  is  emmenagogue,  but  "not  abor- 
tional  or  parturiant  in  the  slightest  degree."  Dr.  Hoi- 
comb  has  no  confidence  in  its  pritudeal  virtues.  The 
writer  has  used  it  many  hundred  times  and  in  all  doses, 
but  never  saw  it  bring  back  the  menses  or  cause  abor- 
tion. Dr.  Tully  had  no  positive  experience  with  it, 
but  quotes  Drs.  Frost,  Cabell,  and  Prof.  Metlauer,  as 
physicians  who  have  tested  it,  and  proved  it  to  act 
powerfully  on  the  uterus.  Since  the  article  in  "New 
Provings"  was  written  I  have  received  a  large  amount 
of  testimony,  both  for  and  against  its  asserted  action 
on  the  uterus.  Time  only  can  clear  up  these  conflict- 
ing statements.  It  may  be  that  the  usual  preparations 
are  inert,  and  only  the  green,  fresh  root  should  be  used. 

Hex  Opaca. 

The  American  Holly  is  mentioned  by  Prof.  Tully  as 
having  the  reputation  of  being  a  powerful  "ecbolic." 

*  New  Provings,  page  217. 


CAUSES   OF   ABORTION.  101 

It  is  an  evergreen  tree,  from  20  to  40  feet  in  height, 
and  is  found  growing  throughout  the  United  States, 
from  Maine  to  Louisiana,  but  is  especially  abundant  in 
the  district  of  Abbeville,  S.  C.  Dr.  Tully  states  that 
he  was  informed  by  several  physicians  of  that  region 
that  it  had  a  "  high  popular  reputation  as  an  ecbolic,  it 
being  considered  capable  of  producing  abortion  or  mis- 
carriage at  any  stage  of  pregnancy."  A  strong  infusion 
or  decoction  of  the  leaves  is  to  be  drank  freely.  Its  use 
seems  to  be  confined  to  the  negroes.  Dr.  Tully  could 
not  ascertain  that  one  educated  physician  had  ever 
made  a  trial  of  it  in  a  single  case ;  yet  he  was  told  that 
no  intelligent  "physician  doubted  its  efficacy  in  that 
direction. 

I  cannot  find  in  any  work  on  materia  medica  or  ther- 
apeutics any  mention  of  the  ilex,  as  a  medicine  speci- 
fically affecting  the  uterus.  It  has  never  been  used  in 
Homoeopathic  practice  that  I  am  aware  of.  It  is  to  be 
hoped  that  some  intelligent  and  investigating  physician 
will  test  its  pathogenetic  powers,  and  add  it  to  the  list 
of  our  curative  agents. 

Mercurius. 

Ever  since  the  introduction  of  this  deleterious  drug, 
instances  have  not  been  wanting  of  its  prejudicial  effects 
upon  the  foetus  in  utero.  The  older  physicians  observed 
that  large  doses  of  calomel  administered  to  pregnant 
women,  were  frequently  followed  by  abortion. 

Stille*  mentions  that  the  inhabitants  of  districts 
where  ores  of  mercury  are  smelted  are  seriously  affected 
by  its  influence.  "  The  annual  mortality  is  more  than 
1  in  40.  Premature  birtlis  and  abortions  are  very  com- 

*  Materia  Medica  and  Therapeutics. 


102  HALE    ON   ABORTION. 

mon"  Dr.  Lizi  had  an  extensive  observation  of  female 
operatives  exposed  to  mercurial  vapors.  "Marriages 
among  them  were  vastly  more  productive  of  abortions, 
stillbirths,  and  feeble  children  which  seldom  arrive  at 
maturity,  than  among  women  engaged  in  other  occu- 
pations." Dr.  Colson,  who  wrote  of  the  action  of  mer- 
c '//•//  on  the  uterus,  says — "  In  not  a  few  instances  has 
it  occasioned  menorrhagoaa  or  amennorrhcea,  and  in 
pregnant  females  jniscariiage"  More  recent  writers 
mention  the  fact  that  calomel  frequently  causes  abortion. 
I  was  once  informed  by  an  Allopathic  physician  whose 
practice  lay  in  a  rather  disreputable  direction,  that  he 
knew  of  no  surer  producer  of  abortion* than  a  massive 
dose  of  calomel — its  hydro-cathartic  effect  was  generally 
followed  by  expulsion  of  the  foetus.  A  woman  once 
informed  me  that  she  usually  arrested  her  pregnancies 
by  a  large  dose  of  calomel  at  a  menstrual  period. 


This  active  drastic  cathartic  has  been  known  to  cause 
abortion.     I  have  been  informed  that  the  podophyllin 
is  often  administered  for  that  purpose  by  certain  dis- 
reputable Eclectic  physicians.     It  probably  acts  in  a 
similar  manner  to  aloes,  calomel,  and  other  medicines 
which  highly  irritate  the  lower  intestines,  and  by  sym- 
pathy the  organs  of  the  pelvis.     In  large  doses  it  is 
frequently  and  often  successfully  used  in  amenorrhcea, 
yet  I  cannot  believe  it  has  any  such  specific  influence 
over   the   uterus   as  caulopJtyllum   and   some   others. 
When  threatened  abortion  is  attended  with  piles,  dys- 
v.   prolapsus   ani,   bilious   diarrhoeas  'or  extreme 
H-  prolapsus,  this  medicine  will  be  indicated  as  a 
•rive  uvLr«'iit. 


CAUSES    OF    ABORTION.  103 

QuinicB  Sulphas. 

In  another  portion  of  this  volume  will  be  found  some 
mention  of  quinine.  In  the  massive  doses  (30  to  40 
grains)  used  in  Allopathic  practice,  it  has  probably 
caused  abortion,  when  given  for  the  cure  of  malarious 
fevers.  Dr.  Petitjean  affirms  that  he  has  so  frequently 
seen  abortion  produced  during  the  exhibition  of  quinine 
in  intermittent  fever,  that  he  has  ceased  to  prescribe  it 
for  pregnant  women.*  Dr.  A.  K.  Gardner  asserts  that 
the  administration  of  quinine  to  pregnant  women  is 
hazardous,  and  likely  to  cause  premature  labor. f 

These  statements  are  opposed  by  Rodriques  and 
Henry,  who  attribute  the  abortion  to  the  disorder  of 
the  general  health,  and  the  "mechanism  of  the  par- 
oxysm" during  malarial  fevers.  Dr.  Rich,  of  Georgia, 
attributes  to  it  the  suspension  of  contractions  of  the 
uterus  threatening  abortion  under  similar  circumstances. 
By  some  physicians  it  has  been  alleged  to  render  uterine 
contractions  more  active  during  labor,  and  as  a  means 
of  overcoming  rigidity  of  the  os  uteri. 

Quinine  is  Homoeopathic  to  many  of  the  symptoms 
of  abortion  and  its  consequences,  and  will  be  found  a 
useful  remedy,  especially  in  malarious  districts. 

Ruta  graveolens. 

This  is  a  very  old  medicine,  used  by  Hippocrates  and 
other  ancient  physicians  for  a  variety  of  diseases,  among 
which  was  menorrhagia.  Hippocrates,  however,  says 
it  "  excites  the  menstrual  flow,  and  destroys  the  foetus 
in  utero."  M.  Helie,  in  1838,  published  three  cases  of 
attempts  to  produce  abortion  by  this  plant,  in  one  of 

*  Lancet,  4th,  1847. 
f  Tyler  Smith's  Lectures  on  Obstetrics,  by  Gardner. 


104  HALE   ON   ABORTION. 

which  a  decoction  of  the  fresh  sliced  root,  in  the  second 
a  decoction  of  the  leaves,  and  in  the  third,  the  expressed 
juice  of  the  leaves  was  taken.  The  effects  were,  in  one 
case,  violent  pain  in  the  stomach,  and  vomiting,  or 
rather  efforts  at  vomiting,  with  rejection  of  a  small 
quantity  of  blood.  In  all  of  the  cases  the  nervous  sys- 
tem was  prominently  deranged ;  there  was  great  pros- 
stration,  with  confusion  of  the  mind  ;  cloudiness  of  the 
vision  with  feebleness  of  pulse ;  cold  extremities,  and 
twitching  of  the  limbs.  All  of  the  females,  who  were 
in  the  fourth  or  fifth  month  of  pregnancy,  aborted  and 
recovered.  Hahnemann  records  the  effects  of  ruta  thus: 
"  Metrorrhagia  ?  Miscarriage  ?  Sterility  ?"  It  would 
seem  that  he  doubted  its  power  of  causing  abortion :  a 
doubt  which  other  observers  do  not  share.  Stille  says 
it  is  emmenagogue,  and  "  not  only  like  ergot  acts  upon 
the  gravid  uterus,  but  it  stimulates  the  unimpregnated 
organ  also."  M.  Bean  recommends  it,  associated  with 
savin,  in  uterine  Itcemorrliage  after  abortion,  and  men- 
orrhagia  from  general  debility. 

Sabina. 

The  Juniperus  Sabina  is  a  native  evergreen  shrub  of 
Southern  Europe,  and  is  cultivated  as  an  exotic  in  gar- 
dens in  this  country.  The  Juniperus  procumbens,  a 
species  having  very  similar,  if  not  identical,  properties, 
is  found  growing  on  the  shores  of  our  north-western 
lakes.  I  have  met  with  it  in  the  interior  of  Michigan, 

O          ' 

and  also  on  the  sand-dunes  which  cover  the  southern 
shore  of  Lake  Michigan.  It  has  been  found  on  the 
shores  of  Lake  Huron.  It  throws  out  its  branches  very 
close  to  the  ground,  spreading  in  large  circles,  generally 
quite  horizontal,  but  often  growing  upward  at  a  slight 
angle  of  perhaps  10  or  20  degrees.  This  indigenous 


4  CAUSES   OF   ABOKTION.  105 

variety  should  be  proven,  in  order  to  test  its  compara- 
tive effects. 

Dioscorides  was  the  first  to  describe  the  qualities  of 
savin.  Among  other  things,  he  says,  "  An  infusion  of 
them  in  wine  causes  bloody  urine,  and  applied  as  a 
fomentation  to  the  belly  of  pregnant  women,  they  pro- 
duce abortion"  Galen  says  it  " Excites  the  menses 
more  powerfully  than  any  other  agent,  provokes  bloody 
urine,  destroys  the  life  of  the  foetus,  and  causes  its  expul- 
sion" "  But,"  says  Stille,  "  it  was  most  celebrated  for 
its  emmenagogue  properties,  which  were  habitually 
invoked  for  the  criminal  purpose  of  destroying  the  pro- 
duct of  conception."  This  belief  of  the  power  of  savin 
to  cause  abortion  has  been  perpetuated  to  this  day,  and 
it  is  now  frequently  resorted  to  for  that  criminal  pur- 
pose, notwithstanding  the  almost  certainly  fatal  conse- 
quences resulting  from  its  administration  in  doses 
sufficient  to  cause  the  destruction  and  expulsion  of  the 
foetus.  The  annals  of  medical  jurisprudence  abound  in 
cases  of  fatal  poisoning  by  savin  taken  to  produce  mis- 
carriage. It  is  much  more  employed  than  is  commonly 
imagined  for  criminal  purposes,  but  fortunately  in  such 
doses  as  fail  of  their  purpose,  and  only  produce  instead 
vomiting  and  purging.  It  generally  produces  inflam- 
mation of  the  intestines  and  urinary  organs,  and  some- 
times congestion  of  the  brain.  A  case  is  reported  by 
Mohreuheim  of  a  pregnant  female  who  took  an  infusion 
of  savin  to  produce  abortion.  It  caused  incessant  vom- 
iting, and  some  days  afterwards  excruciating  pains, 
abortion,  flooding,  and  death.  Rupture  of  the  gall- 
bladder was  found  on  examination  of  the  body,  and  an 
effusion  of  bile  into  the  abdominal  cavity,  with  perito- 
nitis. Many  other  cases  might  be  quoted.  Hahnemann 
records  several  of  an  interesting  character,  by  which  he 


106  HALE   ON   ABORTION. 

was  led  to  recommend  its  use  in  cases  of  abortion.  In 
most  cases  enteritis-mucosa,  and  peritonitis  were  de- 
tected after  death.  Tally  says,  "  The  active  principle 
of  sabina  has  exactly  the  same  composition  as  oil  of 
turpentine,  if  it  is  not  identically  the  same  in  all  res- 
pects." It  is  a  carious  fact,  apparently  confirmatory  of 
this  statement,  that  the  external  application  of  both 
savin  and  turpentine  to  the  abdomen  of  pregnant 
women,  will  often  cause  abortion.  Both  agents  seem 
to  have  a  similar  effect  on  the  intestines,  urinary  organs, 
.skin,  and  general  organism. 

Sabina,  in  poisonous  doses,  acts  most  powerfully  upon 
plethoric  women,  whose  menses  are  habitually  profuse. 
In  such  constitutions  it  would  be  more  apt  to  provoke 
an  abortion,  than  in  persons  of  spare  habit,  even  if  they 

menstruated  profusely. 

• 

Secale  cornutum. 

Although  ergot  has  been,  used  as  a  uterine  motor 
stimulant  since  the  year  1096,  yet  its  modus  operandi, 
as  well  as  its  general  and  local  action,  seems  far  from 
being  understood. 

It  seems  quite  settled,  however,  that  it  will  cause 
inteiwittent  contraction  of  the  uterus  at  full  term.  That 
it  is  capable  of  causing  abortion  seems  to  be  generally 
doubted.  Says  Stille :  "  If  we  examine  the  influence 
of  ergot  upon  the  gravid  uterus  in  the  earlier  stages 
of  pregnancy,  and  before  quickening,  when  it  is  most 
likely  to  be  resorted  to  with  criminal  intentions,  we 
shall  find  that  in  proportion  as  we  recede  from  tlie 
period  at  which  the  spontaneous  action  of  tlie  womb  be- 
gins, ergot  fails  to  exhibit  its  peculiar  influence."  M. 
Dargan,  in  his  report  to  the  Academy  of  Medicine, 
says :  "  We  do  not  believe  that,  independently  of  labor, 


CAUSES    OF    ABOETION.  107 

of  direct  manipulation,  or  of  some  other  external  in- 
fluence, that  ergot,  of  itself,  can  excite  uterine  contrac- 
tions during  the  first  half  of  pregnancy."  Stille  re- 
marks that  this  is  probably  the  opinion  of  physicians 
who  have  had  the  best  opportunities  of  studying  the 
subject.  It  is,  however,  to  be  recollected — he  says — 
that  the  distension  of  the  uterus  at  this  period  is  a 
normal  condition,  and  it  does  not  follow  that  an  equal 
or  even  a  less  degree  of  enlargement  should  not  have 
a  different  result  when  it  depends  upon  morbid  causes. 
This  is  the  case  in  menorrhagia.  It  was  so  in  a  singu- 
lar accident  reported  by  Dr.  Taylor,  of  New  York.  A 
female  who  was  not  pregnant  had  some  leeches  applied 
to  the  neck  of  the  uterus  to  relieve  engorgement  of  that 
organ.  One  of  them  found  its  way  into  the  cavity  of 
the  uterus^  where  it  occasioned  bearing-down  pain  and 
a  bloody  discharge.  Ergot  was  administered,  and  a 
clot  expelled  holding  in  its  centre  a  dead  leech.  Ac- 
cording to  Dr.  Ker,  an  enlarged  and  prolapsed  uterus 
contracted  under  the  use  of  ergot  so  that  it  could  be 
placed  in  situ.  If  we  examine  the  annals  of  criminal 
abortion,  we  find  that  enormous  doses  of  ergot  have 
been  taken,  sometimes  with  fatal  effect  upon  the  mother, 
and  often  to  the  production  of  serious  disease,  without 
causing  the  expulsion  or  death  of  the  foetus.  In  other 
cases  the  life  of  the  foetus  was  destroyed,  but  it  was  not 
expelled.  Two  very  interesting  cases  of  poisoning  by 
ergot  are  published  in  the  "  Transactions  of  the  New 
York  State  Homeopathic  Society,  vol.  ii.,"  in  one  of 
which  160  grains  of  ergot  were  taken,  causing  a  serious 
illness,  but  without  "  any  pains  or  signs  of  labor,"  and 
pregnancy  went  on  uninterrupted.  In  the  other  case, 
reported  by  Dr.  Hill,  half  an  ounce  of  ergot  was  taken 
to  produce  miscarriage,  by  a  woman  who  was  evidently 


108  HALE    ON    ABORTION. 

not  pregnant,  but  affected  with  uterine  haemorrhage 
due  to  irritation  of  the  uterus.  In  this  there  were 
"pains  of  an  expulsive  character  in  the  uterus"  the 
first  day,  and  continued  "  pain  in  the  vulva"  nearly 
every  day  until  she  died.  I  have  known  it  to  cause 
expulsive  pains  in  passive  menorrhagia. 

,  Effects  of  ergot  upon  gravid  animals. — It  is  important 
that  we  should  study  this  point.  Stille  says,  "The  in- 
fluence of  ergot  upon  the  gravid  uterus  in  animals  is 
not  uniform.  In  some  cases  it  seems  to  have  been 
purely  negative,  in  others  to  have  destroyed  the  pro- 
duct of  conception  without  producing  its  expulsion, 
and  in  still  others — and  these  are  the  most  numerous 
—to  have  caused  abortion.  Bonjean  gave  ergot  to  a 
female  guinea  pig  during  the  early  stages  of  gestation  ; 
abortion  was  not  occasioned,  nor,  indeed,  any  symptom 
whatever.  The  experiments  of  Wright  were  to  this 
effect.  He  mixed  ergot  with  the  food  of  a  pregnant 
rabbit;  no  tendency  to  abortion  was  excited,  and  in 
due  time  six  healthy  young  ones  were  born.  The  ani- 
mal, still  kept  upon  the  same  food,  was  again  impreg- 
nated. She  looked  drowsy  and  moped,  the  fur  grew 
erect  and  rough,  gestation  was  protracted  beyond  its 
usual  term,  and  three  young  ones  were  born,  two  of 
which  were  dead,  and  the  third  survived  but  a  few 
hours.  The  same  experimenter,  after  many  trials  of 
ergot  upon  pregnant  bitches,  concluded  that  it  did  not 
act  as  a  parturifacient  in  them,  although  it  sometimes 
appeared  to  injure  or  destroy  the  product  of  concep- 
tion. 

On  the  other  hand,  according  to  Diez,  it  produced 
abortion  in  bitches  and  sows,  without  harm  to  the 
mother  or  the  young,  when  the  dose  was  moderate,  but 


CAUSES    OF   ABORTION.  109 

large  doses  destroyed  both,  and  excited  inflammation 
of  the  womb. 

Dr.  Oslen  gave  ergot  to  a  sow,  a  cow,  and  a  cat,  be- 
fore the  completion  of  pregnancy,  and  in  each  case  pro- 
duced abortion.  In  1841  an  epidemic  of  abortion 
among  cows  occurred  in  France,  which  was  traced  to  the 
ergotted  state  of  the  rye  and  other  graminse  in  the  district. 

The  most  of  the  above  cases  of  abortion  in  animals 
undoubtedly  occurred  during  the  last  half  of  preg- 
nancy. The  same  effect  would  have  been  produced  in 
women  under  similar  circumstances.  After  the  study, 
observation,  and  experience  the  writer  has  bestowed 
upon  ergot,  his  belief  is  that  it  is  capable  of  causing 
abortion  in  animals  and  women,  in  the  early  months  of 
gestation,  in  those  constitutions  which  are  susceptible 
to  its  action.  I  do  not  believe,  however,  that  it  excites 
contractions  and  expulsive  pains  until  it  destroys  the 
life  of  the  foetus.  When  this  occurs  the  enlargement 
of  the  uterus  becomes  an  abnormal  condition,  because 
it  contains  a  foreign  body,  which  is  a  source  of  irrita- 
tion of  itself.  In  this  condition  of  the  uterus  the  ergot 
will  act,  and  cause  expulsive  pains  and  contraction.  In 
the  last  months  of  pregnancy  it  may  induce  premature 
labor,  but  the  child  is  generally  still-born,  so  that  the 
exceptions  to  the  above  rule  are  very  few. 

It  may  be  said  of  ergot  that  it  is  a  dangerous  and 
uncertain  medicine,  when  used  to  cause  abortion,  and 
should  never  be  resorted  to  for  that  purpose. 

Sanguinaria  canadensis. 

This  medicine  is  one  possessing  active  and  varied 
properties,  and  is  capable  of  exercising  a  strong  effect 
upon  the  uterus — whether  direct  or  not  cannot  yet  be 
satisfactorily  decided. 


HO  HALE   ON    ABORTION. 

Rafinesque  cautions  against  its  use  during  pregnancy, 
as  it  acts  very  powerfully  on  the  uterus,  and  causes 
fihui't'nm,  and  recommends  its  employment  in  amenor- 
rhrea.  Tully  says  it  is  sometimes  emmenagogue,  and 
has  been  known  to  produce  uterine  hoemorrhage. 

Many  eclectic  practitioners  assert  that  they  have 
used  it  successfully  in  amenorrhoea  and  infrequent  men- 
struation. They  state  that  a  sure  sign  of  its  remedial 
action  is  the  presence  of  "  pains  in  the  small  of  the 
back,  extending  down  the  thighs."  These  would 
probably  be  the  symptoms  in  abortion  caused  by 
blood-root :  there  would  also  be  other  important  symp- 
toms— as  vertigo,  pain  in  the  head,  narcosis,  vomiting, 
burning  pains  in  the  stomach,  etc.* 

Terebinth. 

The  oil  of  turpentine  is  one  of  the  most  active  and 
powerful  of  that  group  of  medicines  which  affect  the 
uri no-genital  organs.  The  apparent  starting-point  of 
its  action  seems  to  be  in  the  urinary  apparatus,  but 
it  produces  profound  aberrations  in  the  nervous  and 
vascular  systems.  Persons  exposed  to  the  vapors  of 
turpentine  experience  its  general  effects,  such  as  nausea, 
vertigo,  impaired  vision,  pain  in  the  back  and  loins, 
strangury,  bloody  urine,  insomnia,  malaise  and  an 
eczematous  eruption.  Women,  in  addition,  are  often 
affected  with  menorrJiagia  or  dysmenorrhoea.  [Eminent 
Allopathic  authorities  claim  for  it  great  curative  pow- 
ers— which  it  really  has — in  all  haemorrhages,  especially 
those  from  the  uterns  /]  Stillef  says  it  arrests  haemor- 
rhage after  parturition  by  exciting  contractions  of  the 
uterus,  as  it  is  known  to  do,  as  well  as  by  its  styptic 

*  See  New  Homoeopathic  Provings :  Art.  Sanguinaria. 
f  Materia  Medica :   Art.  Tereb. 


CAUSES    OF   ABORTION.  Ill 

(homoeopathic)  powers.  Turpentine  when  taken  inter- 
nally has  been  known  to  cause  ABORTION  and  premature 
labor,  accompanied  or  not  by  the  above-mentioned  local 
and  general  symptoms.  A-  patient  who  applied  to  me 
for  the  cure  of  sterility,  informed  me  that  she  had 
caused  abortion  several  times  in  the  early  months  upon 
her  own  person,  by  simply  rubbing  the  hypogastric 
region  with  the  spirits  of  turpentine.  Several  years 
had  elapsed  since  she  had  been  pregnant ;  her  menses 
were  too  profuse  and  frequent.  By  this  it  would  seem 
to  cause  both  abortion  and  sterility. 

Tanacetum  vulyaris. 

This  common  plant  has  been  perhaps  more  frequently 
resorted  to  for  the  purpose  of  inducing  criminal  abor- 
tion, than  almost  any  other  agent.  The  oil  of  tansy  is 
the  preparation  usually  selected  for  this  purpose.  The 
many  cases  of  death  arising  from  the  use  of  this  power- 
ful poison  do  not  seem  to  deter  the  vicious  or  unfortu- 
nate from  its  use. 

In  overdoses,  the  oil  causes  unconsciousness,  flushed 
cheeks,  dilated  pupils ;  hurried,  stertorous  respiration, 
strong  spasms,  full  and  frequent  pulse,  repeated  con- 
vulsions ;  then  failing  pulse  and  death.  In  a  case  of 
attempted  abortion,  by  a  decoction  of  the  herb,  there 
occurred  delirium,  slow  and  laborious  respiration,  con- 
tracted pupils,  dusky  countenance,  fixed  features,  and 
cool  skin.  Subsequently  the  muscles  of  deglutition 
and  all  the  voluntary  muscles  became  paralyzed,  and 
death  with  gradual  retardation  of  the  heart's  action, 
took  place  in  26  hours  after  the  poison  was  taken.  It 
would  appear  that  the  operation  of  the  tincture  or  de- 
coction of  tansy  was  not  the  same  as  its  essential  oil. 
Both  preparations  have  undoubtedly  been  used  success- 


112  HALE   ON   ABORTION. 

fully  as  abortivants,  without  fatal  or  serious  results ; 
but  its  administration  in  large  quantities  is  generally 
dangerous.  In  the  February  number  of  the  North 
American  Journal  of  Homoeopathy  (1865)  will  be 
found  a  resumS  of  all  that  is  known  concerning  the 
pathogenetic  and  curative  effects  of  tanacetum. 

Ustilago  madis. 

This  wtttago  is  a  parasitic  mushroom,  which  occurs 
on  maize  (Indian  corn)  as  ergot  does  on  rye.  In  a  cow. 
house  where  cows  were  fed  on  Indian  corn  infested  with 
this  parasite,  eleven  of  their  number  aborted  .in  eight 
days.  After  their  food  was  changed,  none  of  the  others 
aborted.  The  better  to  be  convinced  of  the  poisonous 
nature  of  these  mushrooms,  the  author,  after  having 
dried  and  pulverized  them,  administered  six  drachms 
to  two  bitch  dogs  with  young,  which  soon  caused  them 
to  abort.* 

Lindlay  says : — "  Its  action  on  the  uterus  is  as  pow- 
erful as  the  ergot  of  rye,  and  perhaps  more."  Accord- 
ing to  Roulin — "  Its  use  (long  protracted,  of  course)  is 
attended  with  shedding  of  the  hair,  both  of  man  and 
beast,  and  sometimes  even  of  the  teeth.  Mules  fed  on 
it  lose  their  hoofs,  and  fowls  lay  eggs  without  any  slidls" 

Tully  in  his  mention  of  this  fungus  adds — "  It  is 
doubtless  by  its  abortifacient  power  that  it  causes  the 
eggs  of  fowls  to  be  extruded  before  there  has  been  time 
for  a  shell  to  be  formed.  By  what  power  does  it  cause 
the  shedding  of  the  hair  of  man  and  brute  animals  and 
the  casting  off  of  the  hoofs  of  mules  long  fed  upon  it?" 
It  would  seem  to  be  capable  of  great  curative  powers. 

*  Anal.  Med.  Vetr.  Beige,  and  Rep.  de  Ph. 


PART    III. 

GENERATION : 

SYMPTOMS,    DIAGNOSIS,   PATHOLOGY,    MECHANISM, 
AND   PROGNOSIS    OF  ABORTION. 


GENERATION.  115 


SECTION    I. 

GENERATION. 

The  Physiology  of  Generation  is  so  intimately  con- 
nected with  the  subject  of  Abortion,  that  it  would  be 
improper  to  omit  some  mention  of  that  process,  when 
conducted  normally. 

Generation,  in  its  broadest  sense,  is  that  function  of 
the  female  generative  organs  which  dates  from  the  suc- 
cessful impregnation  of  the  ovum  to  the  period  of  its 
birth.  It  includes  the  several  processes  of  contact  of  the 
ovum  with  the  fertilizing  semen  of  the  male,  its  passage 
through  the  Fallopian  tube  into  the  uterus,  certain 
textural  changes  in  the  uterus  in  advance,  and  in  con- 
sequence of  its  reception  and  developement,  and  its 
final  passage  and  parturition. 

I  propose  to  treat  of  Generation  as  including  three 
distinct  stages,  namely, 

(1)  From  the  arrival  of  the  impregnated  ovum  in  the 
uterine  cavity  until  the  placental  attachments  are  per- 
fected, or  the  period  of  quickening. 

The  ovule  has  its  origin  in  the  ovary,  and  when 
it  has  attained  its  full  maturity,  the  vesicle  in  which  it 
is  enclosed  becomes  the  seat  of  an  excitation,  which 
finally  results  in  a  rupture  of  the  walls  of  the  vesicle, 
and  the  extrusion  of  the  ovule.  This  maturation,  and 
escape  of  the  ovule,  generally  occurs  at  or  about  the 
menstrual  periods.  After  its  escape,  the  ovum  engages 
in  the  Fallopian  tube,  the  enlarged  extremity  of  which  has 


116  HALE    ON    ABORTION. 

been  applied  to  the  ovary.  It  has  been  supposed  that 
the  above  processes  occur  from  the  stimulus  of  coition, 
or  erotic  excitement,  as  well  as  from  the  excitation  con- 
sequent on  the  menstrual  crisis ;  but  it  is  doubtful  if 
the  former  uniformly  causes  such  results. 

The  ovum  passes  through  the  Fallopian  tube,  but  the 
time  necessary  for  this  passage  is  not  with  any  certainty 
known.  In  the  human  subject,  says  Cazeaux,  no  one 
case  has  ever  proved  its  existence  in  the  womb  prior  to 
the  twelfth  day.  But  this  cannot  be  accepted  as  any 
decision  of  the  question. 

"When  the  ovum  enters  the  cavity  of  the  uterus,  if  it 
has  been  fecundated  by  the  spermatic  fluid  in  its  pas- 
sage, it  attaches  itself  to  some  portion  of  the  hypertro- 
phied  mucous  membrane^generally  near  the  fundus,  at 
which  portion  the  placenta  is  afterwards  attached. 

It  is  here  necessary  to  make  some  mention  of  the 
decidua.  It  is  now  argued  that  at  each  menstrual 
period  the  uterine  mucous  membrane  is  exfoliated, 
thrown  off,  and  a  new  one  formed  in  its  place.  It  is 
this  membrane,  greatly  hypertrophied,  that  we  find  in 
membraneous  dysmenorrhoea.  It  is  now  well  estab- 
lished that  the  decidua  is  nothing  more  than  the  hyper- 
trophied mucous  membrane.  Whilst  the  evolution  of 
the  ovarian  vesicle  is  going  on  in  the  ovary,  the  vascu- 
larity  of  the  uterine  mucous  membrane  is  greatly  in- 
creased, and  the  highly  congested  vessels  are  discover- 
able beneath  the  epithelium.  This  state  of  turgescence, 
however  diminishes  during  the  last  days  of  the  mens- 
trual epoch,  and  disappears  almost  entirely  sometime 
after  the'  catamenia  has  ceased.  But  if  the  ovule, 
before  leaving  the  ovarian  vesicle,  or  during  its  passage 
through  the  tube,  receive  the  vivifying  influence  of  the 
spermatic  fluid,  the  fecundation  will  maintain  and  in- 


GENERATION.  117 

crease  the  abnormal  excitement  of  the  genital  organs, 
and  then,  instead  of  subsiding,  the  uterine  mucous  mem- 
brane becomes  still  more  turgescent,  of  a  deeper  violet 
color,  and  the  folds  and  wrinkles  increase  so  as  to  more 
than  line  the  cavity  of  the  uterus.  It  is  in  one  of  these 
folds  that  the  ovum  is  enclosed,  after  the  lapse  of  a  period 
as  yet  unascertained,  and  this  fold  of  hypertrophied 
mucous  membrane  which  remains  in  the  uterus,  when 
united,  forms  the  decidua  reflexa  of  authors.  The  ovum 
is  also  enveloped  in  its  own  proper  membranes — the 
amnion  and  chorion. 

From  the  date  of  conception  and  lodgment  of  the 
ovum  in  the  uterine  cavity,  until  about  the  fourteenth 
week  (three  and  a  half  months),  its  nutrition  is  car- 
ried on  by  means  of  imbibition,  or  absorption  through 
the  membranes  that  surround  it.  Up  to  this  period 
tJie  placenta  is  not  attached  to  tJie  uterus,  and  the  con- 
nection between  the  mother  and  child  is  established 
by  means  of  the  allantois.  The  fact  that  before 
the  fourteenth  week  of  gestation  the  placenta  is  not 
attacked  to  the  uterus  should  be  kept  in  mind,  as  it  will 
have  considerable  bearing  on  the  pathology  and  treat- 
ment of  abortion.  This  period '  is  also  that  known 
to  writers  as  the  period  of  "  quickening,"  or  a  time 
when  the  foetus  is  connected  with  the  maternal  circula- 
tion through  the  placental  vessels.  In  a  medico-legal 
point  of  view,  this  is  an  important  date,  as  by  some 
jurists  it  is  considered  a  date  after  which  the  induction 
of  abortion  is  considered  a  criminal  offence,  unless  some 
point  of  medical  expediency  demanded  it. 

(2)  The  second  stage  extends  from  the  date  of  the 
attachment  of  the  placenta  to  the  uterus,  until  the  period 
when  the  foetus  -is  capable  of  a  separate  existence. 


118  HALE   ON   ABORTION. 

The  beginning  and  end  of  this  period,  however,  can 
not  be  said  to  have  any  fixed  limits.  It  is  supposed 
by  some  that  the  period  of  "  quickening"  corresponds 
with  the  attachment  of  the  placenta.  To  a  certain 
extent  this  may  be  true,  as  both  generally  occur  about 
the  sixteenth  week. 

The  age  at  which  a  foetus  is  viable  may  be  said  to  be 
about  the  end  of  the  seventh  month.  Cases  occur  in 
which  children  born  at  an  earlier  time  than  this  sur- 
vive, but  these  are  rare  exceptions.  (Dr.  J.  W.  Francis 
reports  a  foetus  born  with  membranes  intact  in  the 
twenty-third  week  of  pregnancy  that  lived  to  matu- 
rity.) Even  at  the  seventh  month  they  are  kept  alive 
with  difficulty.  The  state  of  the  heart  as  regards 
development,  the  feebleness  with  which  the  foetus  sucks 
before  this  time,  the  ready  failure  of  animal  heat,  and 
the  inability  to  bear  the  movements  necessary  to  nurs- 
ing and  cleansing,  render  it  almost  impossible  to  rear 
the  foetus  born  at  an  earlier  period. 

(3)  The  third  stage  of  utero-gestation  reaches  from 
the  viMUty  of  the  fcetus  until  the  end  of  pregnancy. 

This,  however,  like  the  period  of  viability,  is  a  variable 
period.  According  to  those  authorities  who  consider 
the  last  day  of  the  last  menstruation  the  proper  date  to 
reckon  from,  the  termination  of  pregnancy  varies  from 
the  thirty-seventh  to  the  forty-third  week.  Dr.  Reid, 
whose  elaborate  calculations  appeared  in  the  Lancet, 
gives  the  terminations  of  500  pregnancies,  which  ranged 
from  the  thirty-seventh  to  the  forty-fifth  week.  Dr. 
Reid  also  calculated  from  "a  single  coitus"  in  43  cases, 
all  of  them  resting  upon  testimony  as  credible  as  can 
be  obtained  in  such  cases.  These  ranged  from  260  to 


GENEE  ATION.  119 

300  days,  giving  the  average  duration  of  gestation  at 
about  275  days.  Nine  months  is  supposed  to  be  the 
average  duration  of  human  pregnancy,  but  the  time 
undoubtedly  varies  from  eight  and  a  half  to  ten  months. 

Dimensions  and  weight  of  the  foetus  at  the  different 
periods  of  uterine  life. 

A  treatise  on  Abortion  would  be  incomplete  if  it  did 
not  contain  some  practical  information  on  this  subject. 
In  a  purely  medical,  and  especially  a  medico-legal 
point  of  view,  this  is  of  manifest  importance. 

At  the  time  when  the  embryo  first  begins  to  be 
distinct,  that  is,  about  the  third  week,  it  is  oblong, 
swollen  in  the  middle,  obtuse  at  one  extremity,  though 
drawn  to  a  blunt  point  at  the  other,  and  straight,  or 
nearly  so,  being  somewhat  curved  forward.  It  is 
therefore  vermiform  in  shape,  of  a  grayish  white  color, 
semi-opaque,  almost  without  consistence,  and  gelatin- 
ous, varying  from  two  to  four  lines  in  length,  and 
weighing  one  or  two  grains.  At  this  period  the  only 
trace  of  the  head  is  a  small  tubercle  separated  from  the 
rest  of  the  body  by  a  notch,  but  no  rudiments  of  ex- 
tremities are  observed,  nor  is  there  a  cord  at  first. 

At  the  fifth  week  the  embryo  becomes  more  consis- 
tent ;  the  head  is  large  in  proportion  to  the  body  ;  the 
rudimentary  eyes  are  indicated  by  two  black  spots 
turned  toward  the  sides ;  it  is  nearly  two-thirds  of  an 
inch  long,  and  weighs  about  fifteen  grains. 

At  the  sixth  week,  the  bronchial  fissures  disappear, 
leaving  only  a  slight  cicatrix,  and  its  size  and  weight 
are  somewhat  increased. 

At  the  seventh  week,  the  first  centres  of  ossification 
appear.  The  intestine  still  extends  for  a  considerable 


120  HALE    ON    ABORTION. 


along  the  umbilical  cord.  At  this  time  the 
t-nibryo  is  nearly  an  inch  m  length. 

At  two  months,  the  forearm  and  hand  can  be  distin- 
guished, but  it  is  not  supplied  with  fingers.  The  cord 
has  not  yet  assumed  a  spiral  arrangement  ;  it  is  four  or 
five  lines  in  length,  and  is  inserted  near  the  lowest 
point  of  the  abdomen.  It  is  very  difficult  at  this  period 
to  distinguish  between  the  sexes,  owing  to  the  extreme 
length  of  the  clitoris.  The  embryo  is  from  one  and  a 
half  to  two  inches  long,  and  weighs  from  three  to  five 
drachms. 

At  ten  weeks,  the  embryo  is  from  one  and  a  half  to 
two  and  a  half  inches  in  length,  and  weighs  an  ounce 
or  an  ounce  and  a  half.  The  cord  is  longer  than  the 
embryo,  and  begins  to  assume  the  spiral  arrangement, 
but  its  base  always  contains  a  portion  of  intestine. 
The  fingers  are  distinct,  but  not  the  toes.  At  the  end 
of  the  third  month,  the  embryo  weighs  three  to  four 
ounces,  and  measures  firomjffto  to  six  inches.  The  cord 
contains  no  intestine  ;  the  nails  begin  to  appear,  the 
sex  is  distinct,  the  eyeball  is  seen  through  the  lids,  the 
forehead  and  nose  are  clearly  traced,  and  the  lips  well 
marked  and  not  turned  outward. 

At  ihefowth  month,  the  embryo  takes  the  name  of 
foetus.  The  body  is  six  or  eigM  inches  in  length,  and 
weighs  from  seven  to  eigM  ounces.  The  face  still 
remains  but  little  developed;  the  eyes,  nostrils,  and 
mouth  are  closed  ;  the  skin  has  a  rosy  color,  and  begins 
to  be  covered  with  down,  and  the  muscles  now  produce 
sensible  motion.  "  A  foetus  born  at  this  period,"  says 
Cazeaux,*  "  might  live  for  several  hours.  Whilst  I  was 
Interne  at  the  Hotel  Dieu,  I  received  one  that  had 

*  Cazeaux's  Midwifery,  page  208. 


GENERATION.  121 

scarcely  reached  the  fourth  month.  It  lived,  however, 
from  half-past  seven  to  half-past  eleven  o'clock." 

At  five  months,  the  length  of  body  is  eight  to 
ten  inches,  and  it  weighs  from  eight  to  -eleven  ounces. 
The  skin  is  more  consistent ;  the  pupils  cannot  be 
distinguished. 

At  six  montJis,  the  hair  is  longer  and  thicker,  the 
nails  are  solid,  but  the  eyes  are  still  closed.  The  length 
is  eleven  to  twelve  and  a  half  inches,  and  the  weight 
about  one  pound  (avoir.) 

At  seven  months,  the  eyelids  are  -partly  open,  and 
the  testicles  begin  to  descend  into  the  scrotum.  The 
foetus  acquires  a  length  of  twelve  and  a  half  to  fourteen 
inches. 

At  eight  months,  it  is  only  sixteen  or  eighteen  inches 
long,  and  yet  weighs  four  to  five  pounds,  because  the 
foetus  seems,  at  this  period,  to  grow  rather  in  thickness 
than  in  length.  The  scrotum  generally  contains  one 
testicle,  usually  that  on  the  left  side.  The  skin  is 
very  red,  and  covered  with  long  down.  The  lower 
jaw  is  now  as  long  as  the  upper  one. 

Finally,  at  term,  the  foetus  is  about  nineteen  to  twenty- 
three  inches  long,  and  weighs  from  six  to  seven  pounds. 
Cazeaux  thinks  the  weight  and  length  of  children  at 
birth  have  been  wonderfully  exaggerated,  in  which  he 
is  probably  correct. 


122  HALE   ON   ABORTION. 

SECTION    II. 

SYMPTOMS    OF   ABORTION. 

The  symptoms  of  an  abortion  may  be  divided  into 
three  classes,  namely: 

1.  The  PREMONITORY. 

2.  The  ACTUAL. 

3.  The  SUBSEQUENT. 

Each  of  these  classes,  or  divisions,  constitutes  a  differ- 
ent stage  of  the  miscarriage. 

The  PREMONITORY  symptoms  constitute  the  first  stage 
of  the  abortivant  process,  namely — the  stage  of  irrita- 
tion, or  that  condition  of  tlie  uterus  which  exists  up  to 
tlie  time  of  tlie  rupture  or  separation  of  the  membranes 
or  placenta. 

The  ACTUAL  symptoms  constitutes  the  time  which  inter- 
venes from  the  separation  of  tlie  membranes,  etc.,  until 
the  expulsion  of  thtfcetus  and  placenta. 

The  SUBSEQUENT  symptoms  are  those  which  follow 
and  mark  the  conditions  which  are  lenown  as  tlie  sequelw 
of  aJtortion. 

It  is  important  that  the  above  divisions  be  borne  in 
mind,  as  it  leads  to  a  methodical  study  of  the  subject, 
and  has  an  important  bearing  upon  the  treatment. 

The  symptoms  of  the  premonitory  stage  may  be  said 
to  include  all  those  symptoms  which  belong  to  the 
causes  heretofore  mentioned  ;  but  more  strictly  consid- 
ered, are  those  which  occur  for  a  few  days  or  weeks 
previous  to  the  commencement  of  the  second  stage. 


SYMPTOMS    OF    ABORTION".  123 

The  premonitions  of  an  abortion  may  be  present  for  a 
long  time,  or  only  for  a  few  hours.  This  depends  upon 
the  nature  of  the  causes;  for  if  the  cause  be  an  ulcer 
on  the  cervix,  the  symptoms  may  appear  at  every 
monthly  period,  and  may  not  result  in  actual  expulsion 
of  the  foetus  if  proper  remedial  means  are  used ;  or, 
should  the  cause  be  a  fall,  concussion,  or  instrumental, 
the  premonitory  symptoms  may  be  few,  or  entirely 
wanting. 

The  prodromes  of  an  abortion  generally  appear  in 
the  following  order: 

1.  Pain. — This  may  consist  merely  of  an  aching  in 
the  back   (sacrum)   or  hypogastrium,   and  extending 
down  the  thighs ;  or  it  may  be  acute,  and  described  as 
griping,  lancinating,  darting  or  stitching ;    but  what- 
ever the  character  of  the  pain  may  be,  it  is  generally 
confined  to  the  above  localities. 

2.  Sensations,  which  are  not  pains,  but  consist  of  a 
feeling  of  weight,  pressing-down,  or  soreness,  in  the  hy- 
pogastriuin  and  in  the  pelvis.     These  sensations  may 
co-exist  with  the  pain,  or  may  be  present  without  the 
pains  above  mentioned. 

3.  General  symptoms. —  There  is  almost  always  a 
general  uneasiness,  nervousness,  languor,  and  depression 
of  spirits,  accompanied  or  not  with  some   acceleration 
of  pulse,  flushed  face,  and  cold  extremities.     At  the 
same  time  the  symptoms  which  are  usually  attendant 
on  pregnancy  remain. 

4.  Il&morrliage,  generally  a  slight  discharge,  which 
may  continue  days,  and  even  weeks,  before  the  second 
stage  begins. 

But  so  soon  as  the  membranes  are  broken,  by  acci- 
dent, or  punctured  by  artificial  means ;  or  the  mem- 
branes or  placenta  become  separated  from  the  walls  of 


124  HALE    OX    ABORTION. 

the  uterus ;  or  the  foetus  dies  from  any  cause ;  then  we 
have  a  train  of  symptoms  in  addition  to  the  prodromic, 
namely : 

1.  Chilh. — My  observation  and  experience  goes  to 
show  that  the  chill,  or  rigor,  whether  preceded  or  not 
by  pains  and  sensations,  is  the  most  reliable  symptom 
of  a  rupture  or  separation  of  the  membranes.  The 
foetus  may  die,  and  remain  for  some  time  in  the  uterus 
before  it  excites  irritation  sufficient  to  arouse  the  ex- 
pulsive action  of  that  organ.  Meanwhile  the  placenta 
may  be  said  to  live,  and  even  perform  its  functions,  as 
in  certain  cases  when  the  blighted  or  dead  ovum  is 
changed  to  a  mole. 

In  other  cases  we  may  be  made  aware  of  the  death 
of  the  embryo  by  certain  symptoms  generally  obscure  ; 
but  until  the  woman  has  a  chill,  or  chilly  sensations, 
we  may  consider  separation  of  the  membranes  as  not 
having  occurred.  This  chill  greatly  varies  in  intensity 
and  duration.  '  Sometimes  it  consists  of  a  vague  sensa- 
tion of  internal  chilliness  or  coldness,  and  may  last  for 
days,  and  may  be  mistaken  for  the  first  stage  of  an 
influenza  or  a  fibrile  attack ;  at  other  times  and  in 
other  patients,  it  may  assume  the  form  of  rigors,  in 
which  the  woman  will  shiver  and  shake,  as  during  a 
paroxysm  of  ague.  I  have  seen  instances,  even,  where 
the  attack  could  have  been  easily  mistaken  for  a  "  con- 
gestive chill,"  so  excessive  was  the  prostration  and  the 
general  coMn,-^. 

There  is  a  class  of  cases  in  which  rigors  may  appear 
unattended  by  any  sensations  of  coldness.  These  are 
called,  by  old  nurses,  "  nervous  chills."  The  woman 
will  shiver,  her  teeth  will  "  chatter,"  and  she  will  ap- 
pear to  suffer  from  great  chilliness ;  but  will  tell  you 
she  "is  not  cold."  This  form  of  "rigor"  is  usually  met 


SYMPTOMS    OF    ABORTION.  125 

with  in  cases  of  parturition  at  full  time,  and  is  supposed 
to  indicate  a  relaxation  of  the  circular  mmcles  of  tJie 
cervix,  or  of  any  sphincter  muscle.  I  am  inclined  to 
view  this  as  a  correct  explanation.  In  one  instance  in 
which  I  noticed  this  rigor  without  coldness,  the  embryo 
was  expelled  in  the  unbroken  membranes,  together  with 
the  placenta.  In  this  case,  the  time  which  intervened 
between  the  separation  of  the  membranes,  and  the  ex- 
pulsion of  the  whole,  was  too  short  for  the  appearance 
of  a  chill. 

2.  Pain. — As  in  the  prodromic  stage,  the  pains  may 
be  aching,  cutting  or  griping,  but  they  are  generally 
attended  with  another  kind  known  as  "labor-pains."  A 
woman  may  feel  a  pressing-down  sensation  in  the  pelvis 
during  the  premonitory  stage,  but  that  sensation  is 
quite  different  from  the  one  under  consideration.  A 
labor-pain  is  a  bearing-down  sensation  accompanied  with 
pain :  this  pain  regularly  intermits,  or  remits,  which  is 
rarely  the  case  with  the  premonitory  sensation  alluded 
to.  Some  authors  claim  that  it  is  possible  to  arrest  the 
progress  of  an  abortion  in  the  second  stage.  I  think 
it  hardly  possible,  as  I  have  never  known  such  an  arrest 
to  take  place  after  the  occurrence  of  intermittent,  labor 
like  pain,  coming  on  after  a  chill.  From  the  above,  it 
will  be  noticed,  that  I  consider  the  second  stage  of 
abortion  to  be  marked  by  two  prominent  symptoms, 
namely :  the  chill,  and  the  labor-pain.  There  is  another 
prominent  symptom  of  the  second  stage.  I  allude  to 
the  painful  sensation  of  soreness,  tenderness,  or  sensi- 
tiveness of  the  hypogastric  region,  and  sometimes  the 
whole  abdomen.  This  is  often  so  severe  as  to  lead  to 
the  belief  of  the  presence  of  peritoneal  inflammation, 
which,  however,  rarely  occurs  in  such  cases:  or  more 
correctly  to  the  occurrence  of  nietritis,  which  is  often 


HALE    ON    ABORTION. 

present  to  a  certain  extent.  This  sensation  is  not 
always  due  to  inflammation  or  congestion;  but  is  of- 
tener  neuralgic  in  its  nature,  having  its  seat  in  the 
abdominal  muscles,  or  even  in  the  uterus,  which  is  only 
a  hollow  muscle.  But  as  this  symptom  sometimes  at- 
tends the  prodromes,  and  as  the  abortion  is  often  pre- 
vented after  its  occurrence,  it  cannot  be  considered  as 
belonging  exclusively  to  the  second  stage. 

Pains  may  exist  in  other  portions  of  the  body,  as 
the  back,  thighs,  hypochondria  and  head.  The  pain 
in  the  head  is  particularly  to  be  noted :  it  is  often  in- 
tense, and  aifects  principally  the  top  of  the  head,  and 
the  eyes,  and  is  described  as  a  painful  pressure  from 
within  outwards  (a  pain  quite  similar  to  that  caused 
by  dmicifuga  or  macrotin).  This  pain  in  the  head,  as 
well  as  the  nausea  and  vomiting  which  sometimes  oc- 
cur, is  due  to  reflex  irritation.  Sensations  of  numbness, 
lameness,  and  cramps  of  the  upper  and  lower  extremi- 
ties, sometimes  appear,  and  are  due  to  the  same  cause. 

A  common  symptom  of  the  second  stage  is  a  sensa- 
tion as  if  the  back  (sacrum)  was  dislocated,  or  as  some 
patients  express  it,  "as  if  they  had  no  lack  in  one  place," 
alluding  to  the  sacral  region.  It  is  during  this  stage 
that  we  sometimes  find  considerable  febrile  excitement, 
occurring  generally  subsequent  to  the  chills.  This  fever 
may  come  on  in  irregular  paroxysms,  and  be  followed 
by  perspiration,  and  so  nearly  simulate  certain  forms 
of  ague,  that  the  careless  practitioner  is  often  misled  as 
to  its  real  significance.  Together  with  the  appearance 
of  the  above  symptoms,  we  generally  notice  a  disap- 
pearance of  the  usual  symptoms  of  pregnancy,  or  those 
which  the  patient  has  usually  been  troubled  with,  if 
she  has  borne  children.  The  morning  nausea  and 
vomiting  subsides;  the  "longings"  cease,  and  the  en- 
larged breasts  become  soft  and  flabby. 


SYIVIPTOMS    OF   ABOKTION.  127 

Hcemorrliage. — This  is  almost  invariably  attendant 
on  the  second  stage.  There  are,  however,  some  few 
exceptions  to  the  rule,  as  in  the  case  mentioned  above, 
of  the  expulsion  of  the  unbroken  membranes.  In  this 
instance  absolutely  no  haemorrhage  occurred,  as  I  was 
informed  by  the  nurse,  who  stated  that  only  the  slight- 
est stain  of  blood  appeared  upon  the  napkins  used. 
Hwmorrliage  rarely  occurs  to  any  great  extent  before  the 
expulsion  of  thefcetus:  it  is  from  this  occurrence,  up  to 
the  final  expulsion  of  the  placenta,  that  flowing  is  most 
to  be  feared.  J[  believe  that  no  instance  of  fatal,  or  even 
dangerous  haemorrhage  can  be  cited  as  having  occurred 
previous  to  the  expulsion  of  the  foetus.  It  is  rarely  the 
case  that  the  placenta  is  expelled  at  the  same  time  with 
the  foetus,  or  shortly  thereafter ;  while  the  contrary  ob- 
tains in  delivery  at  full  time.  I  have  often  thought  that 
the  expulsion  of  the  foetus  ought  to  mark  an  interme- 
diate stage,  between  the  second  and  the  third.  Many 
hours  or  days,  and  even  weeks,  may  elapse  between  the 
expulsion  of  the  foetus  and  the  placenta.  Meanwhile 
the  patient  generally  loses  considerable  blood,  which 
may  flow  uninteruptedly,  or  the  flooding  may  occur  at 
longer  or  shorter  intervals.  The  chills,  which  marked 
the  onset  of  this  stage,  may  occur  frequently,  at  irregu- 
lar intervals,  or  if  the  patient  resides  in  a  locality  where 
malaria  abounds,  the  paroxysms  may  occur  regularly, 
and  assume  all  the  characteristics  of  an  idiopathic  inter- 
mittent. It  is  not  strange,  perhaps,  that  intelligent 
physicians  have  treated  such  cases  as  pure  agues,  and 
overlooked  the  intra-uterine  cause.  Anti-periodics,  or 
quinine,  while  they  will  break  the  regular  recurrence  of 
the  paroxysms,  will  not  cause  them  to  subside  entirely, 
nor  will  any  medicine  arrest  them  until  it  first  causes 
the  expulsion  of  the  retained  placenta. 


128  HALE   ON   ABORTION. 

The  placenta  is  frequently  retained  in  the  uterus  until 
putrefaction  takes  place,  in  which  case  it  is[not  expelled, 
in  the  usual  acceptation  of  the  term,  but  passes  away  in 
a  dissolved  or  disintegrated  state.  In  such  cases  the 
discharges  from  the  uterus  have  a  peculiar  and  persist- 
ent fcetor,  unlike  anything  else — a  fcetor  which  the 
physician  who  has  ever  inhaled  it  will  never  forget. 
The  odor  of  the  discharge  from  uterine  cancer  bears 
some  relation  to  it ;  but  there  is  a  marked  difference, 
which  the  experienced  practitioner  can  detect.  It  is 
peculiar  to  both  discharges,  that  it  is  almost  impossible 
for  several  days  to  eradicate  entirely  the  disagreeable 
foetor  from  the  hand  which  has  been  used  in  making  a 
necessary  examination.  The  best  preventive  of  such  a 
disagreeable  contamination  is  to  annoint  the  hand  thor- 
oughly with  fresh  lard,  previous  to  the  examination. 
The  lard  absorbs  the  odor,  and  retains  it,  in  the  same 
manner  as  it  absorbs  the  delicate  and  costly  perfumes 
of  flowers,  which  are  placed  between  layers  of  purified 
lard,  in  order  to  preserve  volatile  odors,  and  transmit 
them  to  pure  alcohol. 

The  decaying  placenta  may  be  weeks  in  passing 
away,  or  it  may  be  expelled  by  the  irritated  uterus 
before  this  process  is  completed.  In  this  case  the 
mass  expelled  has  a  spongy,  worm-eaten  appearance, 
and  exhales  an  intolerable  effluvia. 

In  some  instances  the  placenta  is  neither  expelled  or 
discharged  in  putrefactive  solution,  but  in  some  man- 
ner keeps  up  a  connection  with  the  Uterus,  and  con- 
tinues to  enlarge,  becoming  in  the  end  a  hydatid  or 
molar  mass. 

There  are  even  cases  where  the  after-birth  has 
remained  in  the  uterus  a  long  time,  having  no  connec- 
tion with  that  organ,  remaining  about  the  size  it  had 


SYMPTOMS    OP   ABORTION.  129 

attained  when  the  foetus  was  expelled,  yet  undergoing 
no  change  of  a  putrefactive  character,  and  finally  being 
thrown  off  with  or  without  haemorrhage.  One  such  case 
came  under  my  own  observation.  A  woman  aborted 
in  the  third  menstrual  period  from  conception.  The 
foetus  was  expelled,  considerable  haemorrhage  followed, 
and  it  was  supposed  the  placenta  had  been  thrown  off. 
Ergot  was  given  to  arrest  the  flooding ;  nothing  fur- 
ther occurred  for  a  month,  when  violent  haemorrhage 
occurred,  and  again  two  weeks  after.  At  this  time  I 
was  consulted.  Caulophyllin,  l-10th,  in  doses  of  two 
grains  every  two  hours,  arrested  the  flooding,  and 
under  its  use  for  twenty-four  hours,  the  unchanged  pla- 
centa was  expelled.  No  foetus  was  present  at  the  time 
nor  afterwards.  It  is  supposed  that  in  these  instances, 
putrefaction  is  prevented  by  the  closure  of  the  cervix 
so  tightly  as  to  be  hermetically  sealed. 

We  may  here  inquire  why  the  placenta  is  so  often 
persistently  retained.  But  one  explanation  is  usually 
given,  namely,  that  the  uterus,  before  the  fourth  month, 
is  quite  undeveloped,  and  its  muscular  structure  incap- 
able of  originating  or  maintaining  contractile  or  expul- 
sive action.  That  this  is  often  the  cause  of  the  non- 
expulsion  of  the  placenta  is  not  to  be  disputed,  but 
that  it  is  always  the  cause  of  its  retention  is  certainly 
not  the  case.  Those  who  have  attended  many  cases  of 
abortion,  if  they  are  at  all  observant,  must  have  noticed 
how  frequently  the  uterus  is,  in  such  instances,  more  or 
less  retroverted.  It  has  seemed  to  me  that  this  disloca- 
tion occurs  in  two-fifths  of  all  cases  of  abortion  before 
the  fourth  month.  In  such  a  malposition  the  cervix  is 
flexed,  and  even  bent  at  nearly  a  •  right  angle,  suffi- 
ciently so  as  to  nearly  or  entirely  close  the  canal  of  the 
cervix ;  and  no  amount  of  effort  can  expel  the  placenta 
9 


130  HALE    ON   ABORTION. 

until  the  uterus  is  placed  in  proper  position.  Ante- 
version  of  the  uterus  will  have  the  same  effect,  but  as 
this  occurs  more  rarely,  it  is  not  of  as  much  importance. 
I  have  met  with  but  three  cases  of  this  latter  form  of  dis- 
location occurring  during  the  progress  of  an  'abortion. 
The  uterine  sound  was  here  efficient  in  effecting  the 
change  of  position,  and  dislodging  the  retained  pla- 
centa. 

A  woman  who  has  aborted  may  suppose  she  has  got 
rid  of  the  whole  contents  of  the  uterus,  and  her  phy- 
sician may  be  of  the  same  opinion,  unless  he  has  had 
considerable  experience  and  is  a  close  observer.  There 
may  be  a  slight  discharge,  bloody  or  not,  or  there  may 
be  none  at  all.  This  condition  of  uterine  quiescence 
may  continue  for  days,  and  even  weeks,  when  suddenly 
after  walking,  stooping,  lifting,  or  some  unusual  exer- 
tion, uterine  pains,  with  or  without  haemorrhage,  may 
set  in,  and  a  retained  placenta  be  thrown  off. 

If  the  patient  only  has  pains  while  lying  on  her  fac'e, 
we  may  generally  consider  that  retroversion  exists. 
This  I  have  observed  in  several  instances,  and  upon 
examination,  I  found  that  the  uterus  changed  to  a 

7  O 

natural  position  when  the  woman  lay  upon  her  face, 
and  dropped  into  the  hollow  of  the  sacrum  when  she 
turned  upon  her  back. 

After  the  expulsion  or  discharge  of  the  placenta  and 
membranes,  if  no  coagula  are  present,  the  chills  and 
fever  generally  cease,  but  there  is,  however,  a  kind  of 
irritative  fever,  which  may  occur  before  or  after  this 
period.  It  is  probably  due  to  the  presence  of  a  sub- 
stance undergoing  putrefaction  in  the  uterine  cavity, 
and  the  absorption  of  morbid  matter  into  the  circula- 
tion. This  fever,  although  zymotic  in  its  character,  is 
not,  like  puerperal  fever,  due  to  any  specific  contagion, 


SYMPTOMS  OF  ABORTION.  131 

nor  is  it  propagated  from  one  woman  to  another,  i.  e., 
my  experience  does  not  lead  me  to  suppose  that  any 
such  contagion  is  to  be  apprehended.  I  have  often 
gone  direct  from  the  room  of  a  patient  from  whom  I 
had  just  extracted  a  putrid  retained  placenta,  to  at- 
tend a  woman  in  labor,  using  no  more  than  usual 
means  of  cleanliness,  yet  I  never  had  a  case  of  puer- 
peral fever  in  my  practice  under  such  circumstances. 

This  putrefactive,  or  irritative  fever,  is  usually  at- 
tended with  all  the  symptoms  of  a  typhoid,  namely : 
the  heat  of  the  skin,  quick,  irritable  pulse,  dry  tongue, 
stupor,  or  coma-vigil,  and  even  diarrhoea.  But  it  is  a 
notable  fact,  that  if  at  any  period  of  the  fever  the 
uterus  gets  rid  of  its  morbid  contents,  the  unfavorable 
symptoms  disappear  with  surprising  rapidity,  showing 
that  the  condition  of  the  blood  is  not  due  to  any  fer- 
menting poison  working  in  that  fluid,  but  from  the 
absorption  of  a  poison,  only. 

The  complications  which  may  ensue  during  this 
fever,  are  inflammation  of  the  uterus,  phlebitis,  ovaritis, 
pelvic  cellulitis,  and  occasionally  cystitis ;  but  as  these 
more  usually  occur  as  sequelae  of  abortion,  they  will  be 
considered  under  that  head. 

The  discharges  from  the  uterus  before  all  the  morbid 
material  is  thrown  off,  are  often  irritating  and. excori- 
ating in  the  extreme,  causing  in  their  passage  outward 
superficial  erosion,  and  even  ulceration  of  the  os  uteri, 
vagina,  and  vulva.  I  have  now  described  the  symp- 
toms of  abortion,  in  various  degrees  of  severity,  from 
the  first  premonitus  to  the  entire  expulsion  of  all  the 
products  of  conception.  The  subsequent  symptoms  re- 
main to  be  considered. 

The  sequelae  of  abortion  are  many  and  important, 
comparing  in  gravity  with  those  of  an  unnatural  labor. 


132  HALE   ON   ABORTION. 

It  is  the  opinion  of  some  authors  that  serious  conse- 
quences are  oftener  the  result  of  abortion  than  of  pre- 
mature labor,  but  this  statement  is  hardly  warranted 
by  the  facts.  If  abortion  is  properly  treated,  the 
sequelae  are  very  few  and  unimportant.  It  is  only 
when  this  accident  is  improperly  treated,  or  left  to  the 
unaided  powers  of  life,  that  serious  results  occur.  The 
most  common  sequelae  are  metritis,  ovaritis  (acute  and 
chronic),  induration  and  ulceration  of  cervix  and  os 
uteri,  leucorrhoea,  prolapsus,  retro  version,  chronic  me- 
trorrhagia,  and  anaemia.  To  these  may  be  added  the 
occasional  occurrence  of  mastitis,  peritonitis,  and  puer- 
peral mania. 

The  symptoms  of  the  above  diseases  are  supposed  to 
be  familiar  to  every  practical  physician,  and  are  to  be 
found  in  every  work  on  diseases  of  women.  We  will 
therefore  omit  to  enumerate  them  in  this  place.  In  re- 
lation, however,  to  mastitis,  it  may  be  said  that  the 
mammae  rarely  become  engorged  and  filled  with  milk 
before  the  third  month ;  but  after  that  time  it  is  no 
uncommon  occurrence  to  have  all  the  symptoms  appear 
which  usually  accompany  the  secretion  of  milk  at 
full  time,  and  even  of  the  occurrence  of  mammary 
abscess. 


DIAGNOSIS   OF   ABORTION.  133 


SECTION   III. 

i 

DIAGNOSIS    OF   ABOETION. 

FEOM  the  numerous  and  characteristic  symptoms  just 
given,  the  diagnosis  of  abortion  ought  to  be  very 
easy;  but  unfortunately,  these  signs  are  not  very 
clearly  marked  until  the  abortion  is  inevitable,  and 
consequently  when  it  is  a  matter  of  indifference  to  the 
patient  whether  the  physician  makes  out  a  clear  diag- 
nosis or  not.  It  is  therefore  during  the  premonitory 
stage,  that  we  should  endeavor  to  recognize  the  true 
nature  of  the  disease,  for  then  only  can  our  art  succeed 
in  arresting  its  progress. 

The  diagnosis  of  abortion  involves  the  solution  of 
three  questions : 

(1)  Is  the  woman  pregnant  ?     If  she  is, 

(2)  Are  the  symptoms  those  of  a  commencing  abor- 
tion, or  do  they  arise  from  other  diseases  ? 

(3)  Is  the  abortion  inevitable  ? 

Is  the  woman  pregnant  f  This  first  question  is  quite 
readily  solved  after  the  fourth  month  of  gestation, 
though  before  that  period  it  is  almost  always  unanswer- 
able. All  physicians  of  experience  are  aware  of  the 
difficulties  which  involve  it.  A  woman  in  good  health 
may  cease  to  menstruate  for  several  months ;  she  will 
show  nearly  all  the  natural  signs  of  pregnancy.  At 
the  third  or  fourth  month  she  may  have  signs  of  uterine 
congestion  or  irritation,  lasting  for  several  days,  fol- 
lowed by  a  slight  flow  of  blood.  Is  it  a  return  of  the 
interrupted  menses  or  an  approaching  abortion  ?  The 


134  HALE    ON   ABORTION. 

physician  should  try  to  satisfy  himself,  if  possible,  of 
the  actual  existence  of  pregnancy  (see  "  Conduct  of 
Physician"),  but  if  this  cannot  be  done,  he  must  rely 
upon  the  symptoms  present. 

If  haemorrhage  occurs,  we  must  distinguish  it  from 
those  rare  cases  of  "  menstruation  during  pregnancy," 
so-called.  This  is  supposed  to  be  an  exudation  of  blood 
from  an  ulcerated  os  or  diseased  cervical  canal,  or  from 
the  lower  segment  of  the  uterus,  not  occupied  by  the 
deciduous  membrane.  To  distinguish  it  from  this  ab- 
normal form  of  menstruation,  we  must  ascertain  if  the 
symptom  has  occurred  every  month  since  the  symptoms 
of  pregnancy  set  in,  and  also  the  duration  of  each 
previous  haemorrhage.  If  such  has  occurred,  and  this 
subsides  like  them,  it  is  plain  it  cannot  be  an  impend- 
ing abortion,  unless  such  haemorrhage  proceed  from 
placenta  previa,  as  is  sometimes  the  case. 

Little  or  nothing  can  be  inferred  from  the  form  and 
size  of  the  clot,  whether  it  has  proceeded  from  an  un- 
irapregnated  womb  or  not;  but  all  clots  should  be 
examined,  by  carefully  picking  them  in  pieces  under 
clean  water,  and  if  the  abortion  has  occurred  after  the 
third  week,  the  embryo  may  be  discovered. 

Cazeaux  gives  certain  rules,  laid  down  by  Holl,  how 
to  distinguish  a  clot  in  the  cervix  uteri  from  the  head 
of  the  foetus,  but  our  space  will  not  permit  their  inser- 
tion. 

(1)  Metritis  may  occur  idiopathically  during  preg- 
nancy, when  it  is  pretty  sure  to  cause  abortion.  If  it 
occur  from  medicinal  or  mechanical  causes,  and  for  the 
purpose  of  causing  criminal  abortion,  the  consequences 
are  very  grave. 

To  distinguish  an  impending  abortion  from  inflam- 
mation of  the  uterus  (unimpreguated),  we  must  con- 


DIAGNOSIS    OF   ABORTION.  135 

sider  the  character  of  the  pain,  which  in  the  latter  is 
not  intermitting,  nor  is  there  any  haemorrhage.  A  me- 
tritis  may  be  followed  by  a  foetid  grumous  discharge, 
but  it  lacks  the  peculiar  foetor  of  a  decaying  decidua 
or  placenta.  Finally,  the  history  of  the  case,  and  the 
absence  of  the  usual  symptoms  of  pregnancy. 

(2)  Peritonitis  may  occur  without  causing  abortion. 
The  first  symptoms  of  this  disease,  however,  may  be  mis- 
taken for  symptoms  of  abortion,  particularly  the  ab- 
dominal tenderness,  the  chills,  and  the  tympanites.    But 
the  absence  of  intermitting  uterine  pain,  the  condition 
of  the  os  and  cervix,  and  the  absence  of  haemorrhage, 
will  enable  us  to  form  a  correct  diagnosis.     As  in  ine- 
tritis,  we  may  have  both  a  peritonitis  and  an  abortion 
existing  at  the  same  time. 

(3)  Dysinenwrhcea  has  many  symptoms  which  very 
closely  resemble  those  of  abortion,  so  nearly,  indeed, 
that  it  is  almost  impossible  to  form  a  satisfactory  diag- 
nosis between  that  disease  and  an  abortion  before  the 
tenth  week  of  gestation. 

The  shreds  and  skinny  substances  discharged  in 
membraneous  dysmenorrhoea,  may  not  contain  any  dis- 
coverable foetus  or  placenta.  But  if,  as  I  believe  to  be 
often  the  case,  abortion  occurs  in  the  third  or  fourth 
week  after  conception,  the  embryo  is  so  small  as  to 
elude  a  very  close  search.  In  fact  the  deciduous  mem- 
branes expelled  in  dysmeuorrhcea  and  early  abortion 
are  said  by  recent  investigators  to  be  identical,  and 
sometimes  their  expulsion  is  attended  with  all  the 
symptoms  of  abortion.  It  may  be  said,  therefore,  that 
there  are  many  cases  which  come  under  the  care  of  the 
physician,  where  it  is  impossible  to  give  a  decided 
opinion  one  way  or  the  other. 

(4)  Dysentery.     The  pains  which  accompany  dysen- 


136  HALE   ON   ABORTION. 

tery,  and  are  located  in  the  hypogastrium  and  sacrum, 
extending  in  some  cases  down  the  thighs,  the  tenes- 
mus,  and  desire  to  bear  down  with  the  abdominal 
muscles,  so  nearly  simulate  the  symptoms  of  an  abor- 
tion, that  the  latter  has  often  been  prescribed  for,  as 
dysentery,  especially  if  a  diarrhoea  has  been  present 
with  the  abortion. — a  not  uncommon  occurrence.  But 
no  careful  and  observing  practitioner  will  ever  be  guilty 
of  such  carelessness. 

When  pregnancy  exists,  may  the  symptoms  be  attri- 
buted to  simple  congestion,  or  should  they  be  regarded 
as  the  first  tokens  of  a  threatened  abortion  ?  Although 
it  is  very  difficult  to  decide  this  question  within  the 
first  three  or  four  months,  or  at  the  beginning  of  the 
accident,  its  solution  is  happily  of  little  importance,  as 
regards  the  treatment,  the  measures  indicated  for  simple 
congestion  being  equally  applicable  as  preventives  of 
of  miscarriage.  '  .' -. 

"  When  symptoms,  which  in  all  appearance  were  due 
to  simple  congestion,  have  yielded  to  proper  treatment, 
the  physician  is  often  required  to  answer  a  question 
whose  rigorous  solution  is  always  impossible — namely : 
the  abdominal  and  lumbar  pain  being  allayed,  and  all 
the  other  alarming  symptoms  removed,  is  the  patient 
therefore  out  of  danger  of  miscarriage  ?  In  the  majority 
of  cases  we  can  tell  nothing  about  it,  for  it  is  impossible 
to  know  whether  the  congestion  has  been  arrested  in 
time  to  prevent  a  rupture  of  blood-vessels,  and  an 
effusion  between  the  placenta  and  uterus,  or  whether 
the  separation  of  the  placenta  is  extensive  enough  to 
have  destroyed  the  foetus  immediately  :  even  supposing 
the  child  to  be  still  living,  we  cannot  ascertain  the 
degree  of  separation  of  the  placenta,  nor  foresee  the 
effect  which  a  partial  destruction  of  its  maternal  attach- 
ment may  have  upon  the  foetus.  Very  frequently, 
indeed,  the  latter,  by  being  cut  off  from  a  considerable 


DIAGNOSIS   OF   ABORTION.  137 

part  of  its  means  of  respiration,  is  placed  in  the  condi- 
tion of  an  adult,  whose  lungs  are  in  great  measure  des- 
troyed, and  whose  respiration  and  nutrition  being 
insufficient,  gradually  wastes  away.  As  the  child  often 
does  not  perish  until  after  the  lapse  of  eight  days,  two 
weeks,  and  frequently  not  until  the  next  menstrual 
period,  this,  too,  without  the  appearance  of  any  new 
symptoms  to  explain  the  unlocked  for  death,  the 
physician,  therefore,  cannot  be  too  reserved  in  his 
diagnosis,  as  regards  the  possible  consequence  of  such 
accidents."* 

But  if  the  abortion  has  really  begun,  can  we  hope  to 
arrest  the  symptoms  ?  Severe  pains,  their  constant 
direction  from  the  umbilicus  towards  the  occyx ;  the 
previous  duration  of  the  discharge,  and  the  amount  of 
blood  already  lost ;  softening  and  dilatation  of  almost 
the  entire  neck,  and  even  of  the  internal  orifice,  and 
projection  of  the  membrane  during  contraction,  all  in- 
dicate a  very  unfavorable  prognosis.  It  is  said  by  some 
authorities,  that  these  symptoms  should  not  destroy  all 
hope,  but  I  have  never  known  abortion  arrested  after 
it  has  reached  this  stage.  It  is  even  stated  that  rupture 
of  the  membranes,  and  discharge  of  the  amniotic  fluid, 
does  not  render  abortion  inevitable.  But  this  assertion 
is  simply  absurd  ;  for  such  a  condition  not  resulting  in 
death,  and  expulsion  of  the  embryo  or  foetus,  is  impos- 
sible. In  the  cases  alluded  to  by  Desameaux,  there 
was  certainly  a  mistake  in  reference  to  the  true  origin 
of  the  water  lost  by  the  patient. 

Hydrorrhcea,  resulting  in  discharge  of  water  from  the 
uterus,  has  undoubtedly  been  mistaken  for  rupture  of. 
the  ovum.     Cazeaux  relates  a  case  where  the  occurrence 
took  place  at  three  and  a  half  and  four  and  a  half 
months ;  the  pregnancy  terminated  naturally. 

*  Cazeaux's  Midwifery. 

i 


138  HALE    ON    ABORTION. 

llinwrrhage  may  occur  without  an  abortion  being 
inevitable,  for  it  may  arise  from  an  ulcerated  os,  a  dis- 
eased cervix,  or  even  a  slight  separation  of  the  placenta. 
The  amount  of  discharge  is  more  important  than  its 
duration.  A  slight  haemorrhage  may  continue  for 
several  days  or  weeks,  since  it  may  originate  in  the 
rupture  of  a  few  vessels.  I  have  known  it  to  last  six 
weeks  or  two  months  without  compromisirg  the  preg- 
nancy. But  if  a  large  amount  of  blood  is  lost  in  a 
very  short  time,  the  placenta  must  be  separated  to  a 
considerable  extent,  and  abortion  must  necessarily 
ensue. 

Abortion  is  really  inevitable  only  when  the  foetus 
has  ceased  to  live,  when  the  membranes  have  been 
broken,  or  when  the  separation  of  the  placenta,  and 
the  rupture  of  the  utero-placental  vessels,  are  so  exten- 
sive that  the  remaining  utero-placental  attachments  are 
unequal  to  the  support  of  the  foetal  respiration.  It  is 
impossible  to  ascertain  in  the  early  months  whether  the 
foetus  is  living  or  dead.  The  sudden  cessation  of  the 

O 

vomitings,  salivation,  swelling  of  the  breasts,  and  other 
sympathetic  functional  disorders  of  pregnancy,  are  pretty 
sure  proof  of  the  death  of  the  foetus.  The  continuance 
of  these  symptoms,  even  after  the  occurrence  of  leu- 
corrhoea  and  other  disturbances,  is  certainly  favorable. 
There  is  a  particular  form  of  the  neck  of  the  womb, 
which  Cazeaux  says  is  only  met  with  when  abortion 
has  taken  place.  "  When  the  patient  has  been  for  a 
short  time  only  pregnant,  we  know  that  it  is  always 
easy  to  distinguish  the  neck  of  the  uterus  from  the 
body ;  in  the  great  majority  of  cases  we  may  even  feel 
the  angle  which  separates  them.  Now  when  the  con- 
tractions have  lasted  for  a  certain  length  of  time,  they 
have  gradually  dilated  the  internal  orifice,  the  cavity 


DIAGNOSIS    OF    ABORTION.  139 

of  the  neck  has  become  confounded  with  that  of  the 
body,  and  when  the  finger  in  the  vagina  is  passed  over 
the  entire  lower  segment  of  the  uterus,  the  neck  can  no 
longer  be  distinguished  from  it ;  a  well-defined  limit 
between  them  is  no  more  to  be  detected,  and  all  that 
belongs  to  the  neck  of  the  womb  has  the  shape  of  a 
pear,  the  larger  part  being  continuous  with  the  body 
of  that  organ,  and  the  lower  extremity  corresponding 
with  the  external  orifice.  Whenever  I  have  met  with 
this  condition  of  things,  abortion  has  taken  place."* 

After  the  fourth  month  of  pregnancy  the  diagnosis 
is  much  more  certain,  there  is  greater  haemorrhage,  and 
dilation  of  the  os  is  more  easily  detected,  and  the  death 
of  the  foetus  can  be  verified  in  a  positive  manner.  The 
following  are  the  signs  of  this  occurrence,  (a)  The 
abdomen  diminishes  instead  of  increases  in  volume ; 
(£)  the  breasts  shrink  away ;  (<?)  the  woman  has  drag- 
ging sensations  about  her  loins,  an  unusual  weight  in 
the  hypogastrium,  as  of  an  inert  body  which  falls 
toward  the  side  on  which  she  lies  from  the  mere  law  of 
gravity  ;  (d)  the  movements  of  the  infant  cease  to  be 
perceptible,  (e)  Lastly,  the  most  valuable  evidence  is 
that  furnished  by  auscultation,  for  an  impossibility  of 
hearing  the  sounds  of  the  foetal  heart  after  the  fifth 
month  is  an  almost  certain  sign  of  the  child's  death ; 
indeed  it  is  the  only  sign,  for  all  the  others  may  be 
absent,  and  yet  the  foetus  be  living.  Unfortunately, 
the  pulsations  of  the  heart  are  not  generally  percepti- 
ble before  the  fourth  month  of  pregnancy. 

We  may,  in  most  cases,  be  able  to  diagnose  the  ex- 
istence of  an  abortion  during  its  progress,  and  directly 
after  the  accident ;  but  we  are  often  called  upon  to  treat 

*  Cazeaux  does  not  mean  to  imply  that  that  the  fioetus  and  membranes 
have  been  expelled,  but  that  their  expulsion  is  inevitable. 


140  FATVR   ON   ABORTION. 

the  sequelae  of  abortion,  and,  were  we  not  closely  ob- 
servant of,  and  acquainted  with,  the  symptoms  occur- 
ring from  retention  of  decidual  debris,  or  a  placental 
mass,  we  might  treat  the  patient  for  some  other  malady. 

Retention  in  Utero  of  the  Ovum,  Placenta,  Decidual 
Membrane,  or  parts  of  either. 

It  is  well  known  to  the  profession,  that  the  whole  or 
portions  of  the  product  of  conception  may  be  retained 
in  the  womb,  after  the  vitality  of  the  ovum  has  ceased. 
In  such  cases,  a  putrid  discharge  generally  occurs,  which 
is  sometimes  attended  with  danger  to  life,  and  which 
generally  disappears  after  a  longer  or  shorter  time. 

We  are  often  called  to  cases  presenting  the  following 
array  of  symptoms:  The  woman  is  much  prostrated, 
anaemic,  with  sometimes  an  icterode  hue  of  the  skin  ; 
she  is  very  languid,  hysterical  and  depressed  in  spirits; 
she  may  be  confined  to  her  bed,  or  tries  to  be  up  and 
attend  to  her  domestic  duties  :  in  the  former  case  there 
is  continual  haemorrhage,  or  a  constant  sanious  discharge, 
having  an  abominably  foetid  odor  ;  or  in  the  latter  case 
the  haemorrhage  occurs  occasionally,  at  irregular  inter- 
vals, coming  on  suddenly,  with  or  without  pain.  We 
sometimes  find  the  symptoms  very  severe:  with  the 
prostration  there  will  be  loss  of  appetite,  tumid  or  ten- 
der abdomen,  frequent  small  and  sharp  pulse ;  hot  and 
parched  state  of  the  skin  of  the  hands  and  feet,  hectic 
fever  and  night  sweats.  The  discharge  is  extremely 
fcetid,  and  there  are  frequent  haemorrhages,  brought  on 
by  the  slightest  exertion. 

After  examining  a  case  of  this  character,  the  phy- 
sician will  be  likely  to  pronounce  that  an  abortion  has 
occurred,  and  the  ovum,  placenta,  membranes,  one  or 


DIAGNOSIS   OP   ABORTION.  141 

all,  have  been  retained,  and  are  undergoing  putrefac- 
tion. But  this  would  not  always  be  a  correct  diag- 
nosis. There  are  other  causes  of  the  above 'symptoms, 
all  or  in  part,  namely :  retention  of  the  •  lochia,  of  leu- 
corrhoeal  or  purulent  discharges,  detached  polypi,  can- 
cer of  vagina  or  uterus,  extra-uterine  pregnancy,  disin- 
tegrating fibrous  tumor,  abscess  of  the  genital  organs 
or  pelvis,  and  thrombus  or  hoematocele  of  the  same 
parts.  These  causes  do  not  invariably  produce  all  the 
above  symptoms,  or  any  of  them,  but  they  all  fre- 
quently do  so.  The  same  may  be  said  of  tents,  pessaries, 
or  any  substance  introduced  from  without,  which  will 
decompose,  or  lead  to  retention  of  matters  that  readily 
undergo  putrefaction.  The  art  of  distinguishing  the 
retention  of  the  ovum  and  its  appendages  from  the 
above,  is  one  which  can  only  be  learnt  by  close  study 
and  much  experience.  The  scope  of  this  work  will 
not  permit  a  further  reference  or  an  extensive  differ- 
ential diagnosis.  The  physician  must  judge  from  the 
history  of  the  case.  He  should  first  satisfy  himself 
whether  pregnancy  previously  existed;  other  matters 
should  follow  after. 

There  are  other  consequences  of  imperfect  abortion 
which  differ  from  the  above  symptoms,  in  that  an  early 
ovum,  or  a  part  of  it,  may  be  retained  for  months, 
without  causing  any  discharge  having  a  noticeable 
foetor,  or  indeed  any  discharge  at  all.  These  cases  are 
the  most  difficult  of  diagnosis ;  there  may  be  no  special 
symptom  to  distinguish  the  illness  from  an  ordinary 
uterine  ailment ;  even  an  examination  by  the  touch  or 
speculum  will  fail  to  help  us.  A  case  is  reported  by 
Dr.  Duncan  where  the  ovum  was  retained  seven  months, 
with  the  "  absolute  absence  of  any  foetor."  She  suf- 
fered during  that  time  from  "  weight  in  uterine  region, 


142  HALE   ON    ABORTION. 

slight  bearing  down,  occasional  irritability  of  the  blad- 
der, irregular  action  of  the  bowels,  occasional  disorder  of 
the  stomach,  and  even  sickness,  brownish  leucorrhcea, 
bright  bloody  discharges,  often  profuse,  never  absent 
above  a  week.  At  seven  months  a  sponge  tent  was 
inserted  into  the  cervix,  and  the  next  day  the  ovum 
was  found  in  the  vagina.  It  was  a  placental  mass  an 
inch  and  a  half  broad,  and  above  half  an  inch  thick. 
On  opening  the  bag  of  membranes,  a  few  drops  of  dirty 
brownish  fluid  escaped ;  no  remains  of  an  embryo  or 
cord  was  discoverable,  and  the  ovum  perhaps  never 
contained  any,  being  addle  from  the  beginning."* 


SECTION    IV. 

PATHOLOGY    AND    MECHANISM    OF    ABORTION. 

"  This  is  a  subject,"  says  Dr.  Duncan,  "  which  is  little 
understood."  He  probably  alludes  to  the  changes 
which  take  place  in  the  uterus,  embryo,  placenta,  decid- 
ual  membranes,  etc.,  during  the  process  of  abortion,  and 
not  to  the  causes  of  the  abortion.  The  latter  are 
pretty  well  understood ;  not  completely,  however,  for 
there  are  many  predisponent  and  exciting  causes  which 
are  probably  yet  unknown. 

The  pathological  changes  which  go  on  in  the  uterus 
and  its  contents,  during  an  abortion,  varies  with  the 
stages  of  utero-gestation.  Abortion,  when  it  occurs 
very  early  in  pregnancy  (before  the  twentieth  day, 
during  which  time  M.  Guillemot  calls  it  ovular  abor- 

*  Edinburgh  Medical  Journal,  January  1863,  p.  589. 


PATHOLOGY    AND   MECHANISM    OF    ABORTION.        143 

tion),  is  generally  owing  to  certain  obstacles  which 
prevent  the  permanent  attachment  of  the  ovum  to  the 
uterine  walls.  In  cases  where  conception  has  occurred 
just  before  a  menstrual  period,  the  motor  act  of  expul- 
sion is  probably  limited  to  the  Fallopian  tubes,  the 
ovum  being  carried  out  of  the  uterus  with  the  men- 
strual discharge. 

When  conception  has  occurred  just  after  a  period, 
the  ovum  may  be  dislodged  by  some  mechanical  action, 
or  motor  irritation,  affecting  the  uterus,  in  which  case 
it  would  fall  into  or  near  the  cervix,  and  after  undergo- 
ing disintegration,  pass  off  with  a  leucorrhoeal  dis- 
charge. 

After  twenty  days,  and  until  the  third  month,  or 
fourteenth  week  (embryonic  abortion),  after  the  decid- 
ual  membrane  is  fully  developed,  and  before  the  pla- 
centa has  formed  its  uterine  attachments,  the  great 
vascularity  of  the  uterine  mucous  membranes  renders 
the  effusion  of  blood  between  the  decidua  and  uterine 
walls  an  easy  occurrence.  This  extravasation  may 
arise  from  simple  congestion,  from  rupture  of  a  vessel, 
or  from  separation  of  the  membranes  by  instrumental 
means ;  but  from  whatever  cause  it  arises,  the  blood 
collects  and  spreads  in  all  directions,  separating  the 
decidua  from  its  connections,  and  causing  contractions 
in  the  uterus,  which  generally  end  in  the  expulsion  of 
its  contents. 

In  cases  occurring  in  this  stage,  the  canal  of  the 
cervix  and  the  os  uteri  have  to  be  dilated  before  the 
ovum  can  pass,  and  this  process  of  dilatation  occupies  a 
considerable  time,  and  frequently  causes  much  suffering. 
The  most  favorable  way  in  which  an  early  abortion  can 
occur,  is  when  the  detachment  of  the  entire  ovum  takes 
place  before  the  act  of  expulsion  occurs.  The  perfect 


144  HALE   ON   ABORTION. 

ovum  is  then  expelled  at  once,  and  the  uterus  contracts 
without  much  haemorrhage.  In  other  cases  the  mem- 
branes are  ruptured,  and  the  small  foetus  comes  out 
alone  or  enveloped  in  the  amnion,  or  the  membranes 
may  be  discharged  piecemeal,  leaving  the  ovum  to 
escape  afterward.  As  a  general  rule,  the  membranes 
remain  after  the  expulsion  of  the  embryo,  and  the 
earlier  the  abortion,  the  longer  the  placenta  or  mem- 
branes have  a  tendency  to  remain.  This  is  probably 
owing  to  the  extended  adhesion  of  the  ovum  to  the  in- 
ternal superficies  of  the  uterus,  and  the  feeble  power  of 
the  uterus  to  contract  on  its  contents.  Sometimes  the 
membranes  of  an  early  ovum  will  remain  for  weeks, 
but  in  such  circumstances  there  is  not  the  same  tend- 
ency to  decomposition  and  its  dangers,  as  there  is  in  a 
case  of  placenta  after  the  sixth  month. 

I  have  observed,  in  reading  some  reports  of  cases  of 
abortion  before  the  third  month,  the  remark  that  "  the 
placenta  was  adherent."  Such  a  condition  cannot  exist 
prior  to  that  date,  for  the  reason  mentioned  above,  that 
until  that  time  the  placenta  does  not  form  its  attach- 
ments to  the  uterine  walls. 

Although  the  contractile  power  of  the  uterus  at  this 
date  is  comparatively  feeble,  yet  it  is  sometimes  quite 
notable.  This  contractile  power  has  been  greatly 
underrated.  Dr.  Simpson  has  seen  the  uterus  contract, 
when  unimpregnated,  upon  the  uterine  sound.  The 
virgin  uterus  contracts  violently  during  dysmenorrhoaa, 
and  with  labor-like  pains  expels  the  abnormal  decidua 
("false  membranes").  I  have  known  the  uterus  to 
contract  forcibly,  during  an  abortion,  before  three 
months,  and  the  pains  were  very  like  those  of  labor. 
This  contractile  power  of  the  uterus,  even  at  an  early 


PATHOLOGY    AND   MECHANISM   OF   ABOKTION.        145 

date,  may  be  taken  advantage  of  when  we  are  striving 
to  cause  expulsion  of  the  placenta. 

The  appearance  of  the  masses  discharged  in  early 
abortion,  is  described  with  excellent  minuteness  by  Dr. 
Meyer.*  He  says: 

"  When  these  masses  do  not  prove  to  be  mere  coagula, 
they  present  the  following  appearances :  "  In  form  they 
resemble  internal  coatings  of  the  uterus,  the  fundus  and 
cervix  being  quite  discernable.  The  external  appear- 
ance of  the  mass  is  that  of  a  coagulum  of  blood  with  a 
more  or  less  smooth  surface ;  and  this  it  is  found  to  be 
on  cutting  into  it,  until  we  arrive  at  about  its  middle, 
when  we  come  upon  a  cavity  having  smooth  walls,  more 
or  less  collapsed.  Upon  nearer  examination,  this  cavity 
is  found  to  be  lined  with  two  membranes,  the  chorion 
and  amnion.  An  affixed  funis  is  always  found,  and 
near  its  attachment,  the  umbilical  vesicle,  and  fre- 
quently the  ductus  0ra/?Aafo-inesariacus.  The  free  ex- 
tremity of  the  funis  has  all  the  appearance  of  being 
torn.  These  various  appearances  fix  the  age  of  the 
foetus  at  about  two  months;  but  no  foetus  is  to  be  found, 
or  even  the  fragments  of  one." 

The  conclusion  usually  come  to,  that  no  foetus  has 
been  present,  was  regarded  by  Dr.  Meyer  as  inadmissi- 
ble, and  he  therefore  instituted  a  more  exact  investiga- 
tion into  these  cases.  He  accordingly  found  in  all  of 
them  a  rent,  extending  through  the  membranes,  usually 
at  the  place  which  corresponded  to  the  orifice  of  the 
uterus,  and  this  rent  led  into  a  canal  of  greater  or  less 
length,  amidst  the  external  coagulum.  So  constantly 
is  the  funis  directed  towards  this  rent,  that  in  one  case 
where  the  placenta  was  implanted  more  towards  the 
orifice  of  the  uterus,  and  a  large  rent  had  occurred  at 
the  fundus  of  the  ovum,  the  funis  passed  directly  up- 

*  Henle's  Zeitschrift,  Band,  X.  p.  283. 

10 


146  HALE    ON   ABOKTION. 

wards.  It  is  evident,  then,  that  the  foetus  escapes 
through  the  rupture  of  the  membranes,  and  the  follow- 
ing seems  to  be  the  proximate  cause  of  its  doing  so. 
Abortions  of  this  kind  are  complicated  with  considera- 
able  haemorrhage,  and  the  blood  effused  between  the 
walls  of  the  uterus  and  the  ovum,  whether  in  the  fluid 
state  or  as  a  coagulum,  when  acted  upon  by  the  uterine 
contraction,  compresses  and  bursts  the  ovum.  The 
membranes  collapse,  and  the  funis  becomes  fixed  in  the 
position  it  assumes  on  the  exit  of  the  foetus  through  the 
rupture.  So  small  an  object  as  the  foetus  becoming 
mixed  with  the  coagula  is  easily  overlooked. 

Dr.  Duncan  writes,  in  his  paper  "  On  some  of  the 
Results  of  Imperfect  Deliverance  in  Abortion  :"* 

"  In  abortion  it  sometimes  happens  that  the  entire 
double  layer  of  decidua  is  discharged  with  the  ovum ; 
in  this  case  the  abortion  may  be  truly  called  complete. 
It  also  sometimes  happens  that  the  ovum  alone  is  dis- 
charged, unaccompanied  by  any  decidual  structures; 
and  in  such  cases  the  incomplete  abortion  is  followed, 
after  a  few  hours,  or  even  a  day  or  two,  by  the  expul- 
sion of  the  remaining  decidual  masses.  Occasionally 
no  such  decidual  masses  are  discharged  as  masses,  and 
yet  recovery  is  undisturbed  ;  and  in  cases  of  this  kind 
the  persistent  decidual  membrane  must  either  disin- 
tegrate rapidly,  and  come  away  imperceptibly  in  the 
discharges,  or,  maintaining  its  uterine  connections,  the 
membranes  may  slowly  exfoliate,  and  atrophy  in  like 
manner  as  it  does  after  ordinary  menstruation.  But  it 
also,  though  rarely,  happens  that  the  decidual  masses 
are  retained  for  many  weeks  undecomposed  (perhaps 
adherent  to  the  uterus),  and  then  become  separated, 
putrify,  and  cause  foetid  discharges,  until  they  are  ex- 
pelled." 

In  abortions  occurring  from  the  time  of  the  maternal 
attachment  of  the  placenta  until  the  viability  of  the 

*  Braithwaite,  Part  47,  page  234. 


PATHOLOGY    AND   MECHANISM    OF   ABORTION.        147 

foetus  (the  sixth,  month),  the  mechanism  resembles  more 
closely  the  pains  and  motor  action  of  a  natural  partu- 
rition, and  the  tendency,  as  regards  the  expulsion  of 
the  ovum,  is  to  imitate  labor  at  full  time.  The  patho- 
logical changes  are  the  same  as  in  abortion,  occurring 
during  the  first  stage  of  gestation,  with  this  additional 
feature,  that  the  extravasation  may  occur  between  the 
placenta  and  uterine  parietes,  as  a  result  of  intense  con- 
gestion (placental  apoplexy),  mechanical  separation  by 
instruments,  or  strong  contractions  of  the  womb.  When 
this  occurs  the  membranes  are  also  separated  by  the 
out-pouring  blood,  and  the  uterus  thereby  irritated 
until  its  motor  actions  are  aroused ;  the  cervix  uteri  is 
slowly  dilated,  the  membranes  ruptured  (if  intact  be- 
fore), and  the  foetus  expelled,  to  be  followed  at  a  longer 
or  shorter  interval  by  the  membranes  and  placenta. 
As  gestation  advances  the  cervix  uteri  becomes  devel- 
oped, the  difficulty  of  passing  through  the  cervix  be- 
comes diminished,  while  that  of  passing  the  pelvis  is 
increased.  When  the  ovum  is  small,  the  contractions 
of  the  uterus  are  chiefly  or  solely  concerned  in  its  ex- 
pulsion ;  but  when  it  is  large  enough  to  distend  the 
vagina,  the  abdominal  and  respiratory  efforts  are  called 
into  play.  From  the  sixth  to  the  ninth  month  the 
pathology  and  mechanism  are  nearly  the  same,  but 
more  closely  simulate  natural  labor. 


148  HALE    ON    ABORTION. 


SECTION    V. 

PROGNOSIS    OF    ABORTION. 

Unless  the  abortion  has  been  caused  by  violent 
means ;  or  the  use  of  instruments  in  the  hands  of  the 
the  patient,  or  an  unskillful  or  reckless  physician ;  or 
from  serious  organic  disease,  which  has  previously  pros- 
trated the  vital  powers — the  prognosis  of  an  abortion 
may  genwally  be  considered  as  favorable. 

An  important  element  constituting  a  favorable  prog- 
nosis, is  the  rational  and  scientific  treatment  of  this 
accident.  An  abortion  may  begin  in  a  favorable  man- 
ner ;  the  uterus  may  do  all  that  is  demanded  of  it  for 
the  purpose  of  expelling  the  embryo ;  but  the  treat- 
ment adopted  may,  by  deranging  the  functions  of  other 
organs,  or  arresting  the  natural  efforts  of  the  uterus, 
render  the  result  of  the  case  decidedly  unfavorable. 
On  the  other  hand,  a  case  may  commence  with  the 
most  alarming  symptoms ;  the  uterus  may  fail  to  put 
forth  any  proper  efforts ;  yet  the  skillful  physician,  by 
using  the  medicinal  and  instrumental  means  appropriate 
to  the  case,  may  conduct  it  to  a  safe  and  rapid  termina- 
tion. 

The  period  at  which  an  abortion  occurs  influences  the 
prognosis.  Some  authorities,  among  them  Desamor- 
caux,  assert  that  it  is  more  serious  for  the  patient  in 
the  last  stages  of  gestation.  This  is  not  always  the 
case.  I  arn  inclined  to  agree  with  Cazeaux,  that  "  It 
hardly  constitutes  an  indisposition  during  the  first  and 
even  second  month,  but  in  the  third  or  fourth,  the  ex- 


PROGNOSIS  OF  ABORTION.  149 

pulsion  of  the  foetus  demands  a  certain  dilatation  of  the 
os  uteri,  and  tolerably  energetic  contractions,  for  the 
neck  and  body  of  the  uterus  have  not  yet  undergone 
the  modifications  necessary  to  such  an  effort,  and  the 
delivery  of  the  after-birth  often  presents  difficulties  less 
frequently  met  with  at  a  more  advanced  stage  of  gesta- 
tion ;  whence  I  conclude  that  an  abortion  is  then  more 
grave  and  painful  to  the  patient,  as  also  more  dangerous, 
than  in  the  fifth  or  sixth  month." 

Tyler  Smith  states,  that  "In  abortion  the  danger 
from  haemorrhage  is  before  the  expulsion  of  the  ovum : 
in  labor  at  full  term,  it  occurs  after  delivery."  The 
reasons  for  this  opinion  have  been  given  when  treating 
of  the  Pathology  of  Abortion. 

As  I  have  before  stated,  dangers  rarely  occur  in 
abortion  before  the  sixth  month,  after  the  placenta  is 
expelled  or  has  been  removed. 

A  favorable  prognosis  may  be  given  in  all  cases  when 
the  foetus  and  placenta  has  been  expelled  with  but 
little  haemorrhage  at  or  after  the  occurrence,  or  when 
the  placenta  has  been  removed  before  severe  haemorr- 
hage has  occurred,  or  even  if  the  secundines  cannot  be 
removed  but  pass  off  in  putrefactive  solution  unat- 
tended with  a  low  grade  of  fever. 

It  is  unfavorable  when,  in  cases  of  criminal  abortion, 
such  violence  has  been  used  as  to  cause  serious  inflam- 
mation of  the  uterus,  etc.,  or  injuries  to  that  organ  or 
contiguous  structures.  The  uterus  has  been  lacerated  or 
perforated  by  sharp  instruments,  and  death  has  resulted 
from  internal  haemorrhage  or  peritonitis ;  sharp  probes 
have  been  forced  through  the  bladder,  or  into  the  cul- 
de-sac  between  the  rectum  and  vagina,  causing  serious 
and  sometime  fatal  results.  Caustic  or  acid  fluids  have 
been  injected  into  the  womb  and  caused  death  by  me- 


150  HALE    ON    ABORTION. 

tritis;  or  if  the  substances  injected  passed  through  the 
Fallopian  tubes,  fatal  peritonitis  has  ensued.  Finally, 
the  internal  administration  of  such  poisons  as  wgot, 
sdbina,  and  turpentine,  have  caused  such  intense  uterine 
inflammation,  and  constitutional  disturbance,  as  to 
destroy  life. 

The  instances  above  enumerated  are  usually  those 
which  result  from  criminal  ignorance  or  recklessness, 
and  the  injurious  causes  have  their  origin  in  the  first 
stages  of  abortion.  There  is,  however,  another  class  of 
cases,  which  might  perhaps  be  termed  natural  abortions, 
as  they  are  due  to  some  disorder  of  the  body.  In  all 
these  cases  an  unfavorable  prognosis  can  only  be  feared 
in  the  event  of  two  morbid  conditions  having  obtained, 
viz: 

(1)  The  retention  of  the  placenta  with  flooding. 

(2)  Its  putrefactive  absorption. 

In  cases  of  the  retention  of  the  placenta,  if  it  be  not 
removed,  severe,  protracted,  and  dangerous  flooding 
may  ensue ;  death  may  then  occur  of  sheer  exhaustion 
from  loss  of  blood  unless  the  placenta  is  removed. 

In  other  cases  of  retention,  it  is  not  the  flooding 
only  that  is  to  be  dreaded,  but  the  absorption  of  fluids 
in  a  state  of  putrefaction.  In  quite  a  large  experience, 
however,  I  have  never  lost  a  patient  from  either  cause ; 
in  fact,  I  have  never  lost  a  patient  from  abortion  or 
any  of  its  consequences.  Cases,  however,  do  occur,  of 
death  from  flooding,  or  irritative  fever,  as  also  from 
some  of  the  sequelae  of  this  accident. 

Two  cases  will  illustrate  how  a  little  medicinal  or 
instrumental  interference  may  change  the  most  unfa- 
vorable case  into  one  of  only  moderate  danger,  and 
insure  final  recovery.  I  was  once  called  to  see  a  woman 
said  to  be  dying.  Three  allopathic  physicians  had  at- 


PEOGNOSIS  OF  ABOKTION.  151 

tended  her  for  six  weeks,  and  diagnosed  "  inflammation 
of  tlie  womb  with  gangrene."  She  appeared  nearly  in 
a/rticulo  mortis;  pulse  scarcely  perceptible,  face  hip- 
pocratic,  skin  cold  and  covered  with  a  clammy  sweat. 
The  discharge  per  vaginuni  was  most  intolerably  offen- 
sive. I  got  a  hasty  history  of  the  case,  but  sufficient 
to  satisfy  me  that  an  abortion  had  occurred  about  eight 
weeks  previously.  Ohina,  in  thirty-drop  doses,  was 
alternated  half  hourly  with  the  same  quantity  of  the 
wine  of  ergot.  Brandy  and  food  were  given  freely.  In 
six  hours  a  horribly  offensive  placental  mass  was  ex- 
pelled. The  patient  made  a  rapid  recovery.  The 
other  case  was  a  nearly  similar  one,  except  that  death 
was  imminent  from  profuse  flooding,  which  the  tampon 
or  medicines  had  been  powerless  to  arrest.  The  blunt 
hook  was  introduced,  and  the  placenta  removed ;  haem- 
orrhage ceased  immediately,  and  the  woman  had  a 
favorable  convalescence. 

We  have  considered  the  immediate  prognosis,  and  it 
will  be  noticed  that  we  do  not  coincide  with  the  old 
proposition  which  has  been  advocated  since  the  time  of 
Hippocrates,  viz.,  that  the  prognosis  is  more  grave 
than  that  of  labor  at  full  time.  But  the  remote  conse- 
quences are  undoubtedly  more  disastrous  in  the  former 
case.  Thus  the  acute  diseases  which  attack  lying-in 
women  are  more  frequent  after  labor,  whilst  the  chronic 
disorders  of  the  genital  organs  which  appear  in  ad- 
vanced age,  are  more  common  in  females  who  have 
often  aborted  than  in  those  who  have  been  delivered 
at  term.  Again,  it  is  highly  important  to  notice  the 
unfavorable  influence  which  one  abortion  has  on  subse- 
quent pregnancies,  for  whenever  a  woman  has  had  a 
miscarriage  she  is  more  predisposed  than  others  to  a 


152  HALE   ON   ABORTION.  ' 

similar  accident,  and  hence  great  precautions  should 
always  be  taken  to  prevent  it. 

"The  prognosis,"  says  Cazeaux,  "as  regards  the 
foetus,  is  always  fatal."  This  author,  however,  limits 
abortion  to  the  period  preceding  the  time  of  viability 
fixed  by  law,  namely,  the  end  of  the  sixth  month. 
He  admits  that  cases  are  reported  of  children  born 
prior  to  this  period  which  have  lived;  but  these 
examples,  he  says,  even  if  they  were  authentic,  are  too 
rare  to  invalidate  his  general  proposition. 


PART    IV. 

TREATMENT  OF  ABORTION. 


TREATMENT    OF   ABORTION.  155 


SECTION    I. 

TREATMENT    OF   ABORTION. 

The  treatment  of  abortion  may  be  divided  into 

1.  PREVENTIVE. 

2.  REMEDIAL. 

a.  Mechanical. 

b.  Medicinal. 

3.  POST-PARTTJM. 

a.  Postural. 

b.  Dietetic. 

c.  Medicinal. 

This  excellent  division  is  the  one  adopted  by  my  col- 
league, Dr.  Ludlam,  in  his  Lectures  on  Obstetrics,  and 
I  have  appropriated  it  as  the  most  methodical  and 
scientific  which  has  come  under  my  observation. 

I.  PREVENTIVE. 

The  preventive  treatment  of  abortion  consists  mani- 
festly in  the  remedial  measures  adopted  for  the  removal 
of  those  diseases  which  have  been  enumerated  as  being 
the  causes  which  have  a  tendency  to  result  in  the  death 
of  the  ovum ;  the  separation  of  the  membranes  and 
the  expulsion  of  all  the  products  of  conception. 

(1.)   Constitutional  or  Predisponent. 

Pletliora. — If  this  condition  is  caused  by  an  excess  of 
nutritive  material  taken  into  and  assimilated  by  the 


156  HALE    ON    ABORTION. 

organism,  the  proper  treatment  would  seem  to  be  the 
adoption  by  the  patient  of  that  diet  which  would  most 
effectually  cut  off  the  supply  of  tissue-making  material. 
It  is  the  opinion  of  the  best  physiologists  of  the  present 
day  that  the  ingestion  of  starchy  or  saccharine  matter 
directly  tends  to  cause  corpulence.  It  matters  not 
whether  starch  or  sugar  be  taken  into  the  stomach  as 
such,  or  whether  they  are  generated  in  the  stomach 
from  other  substances  which  contain  the  elements  of 
starch  or  sugar.  It  is  proper,  however,  that  we  should 
distinguish  plethora  from  corpulence  or  adiposis.  The 
former  may  consist  in  an  excess  of  blood  alone,  or  it 
may  be  associated  with  the  latter.  Adiposis,  it  is  well 
known,  may  and  does  often  exist  when  there  is  no  real 
sanguineous  plethora,  in  which  case  the  food  is  improp- 
erly digested,  leaving  the  fatty  particles  to  be  absorbed 
and  deposited  in  the  tissues  (muscles,  etc.),  sometimes 
to  the  entire  destruction  of  their  integrity.  In  true 
sanguineous  plethora,  a  low  diet,  or  the  prohibition  of 
meat,  soups,  pastry,  and  certain  vegetables,  as  beans, 
peas,  etc.,  also  such  beverages  as  tea,  coffee,  brandy  and 
other  liquors,  should  be  insisted  upon.  If  the  plethora 
be  associated  with  adiposis,  all  carbonaceous  articles  of 
food,  sugar,  starch,  etc.,  and  malt  liquors,  should  be 
strictly  prohibited.  If  it  is  found  difficult  to  subject 
the  patient  to  these  restrictions  at  her  home,  it  will 
hasten  the  removal  of  the  plethora  if  we  place  the 
patient  in  a  water-cure  establishment,  or  subject  her  to  its 
processes  under  the  care  of  an  experienced  nurse,  whose 
duty  it  should  be  to  regulate  the  diet  as  well  as  apply 
the  proper  baths,  etc.  The  Turkish  vapor  bath  has 
some  reputation  in  England  for  the  removal  of  pleth- 
oric conditions. 

There  are  certain  medicines  which  have  a  dynamic 


TREATMENT    OF   ABOETION".  157 

influence  over  the  circulation  of  blood  to  the  extent  of 
retarding  the  nutrition  of  the  body.  Dr.  Rogers,  of 
Michigan,  asserts  that  the  veratrum  viride,  in  doses  of 
five  or  ten  drops  of  the  first  dilution  several  times 
daily,  will  tend  to  the  arrest  of  the  plethoric  condition. 
If  this  should  prove  to  be  a  fact,  then  we  may  presume 
that  aconite^  gelseminum  and  others  of  its  analogues 
may  have  the  same  effect.  It  is  supposed  by  some 
authorities  that  excessive  water-drinking  will  have  the 
result  to  diminish  the  amount  of  plethora,  by  acting  as 
a  diluent  of  the  blood,  but  the  value  of  this  theory  is 
more  than  doubtful. 

In  true  corpulence,  or  adiposis,  a  somewhat  different 
treatment  is  required.  It  consists  principally  in  the 
withdrawal  from  the  food  of  all  starchy  and  saccharine 
substances,  obliging  the  patient  to  live  almost  ivholly 
upon  meat.  The  advantages  of  this  plan  of  treatment, 
with  its  successful  results,  is  best  set  forth  in  a  pamph- 
let by  a  Mr.  William  Banting,  of  England,*  who,  from 
being  excessively  corpulent,  weighing  202  Ibs,  after 
living  on  the  the  following  diet  for  one  year,  found  his 
weight  reduced  46  Ibs,  and  his  "girth"  around  the 
waist  twelve  and  a  half  inches. 

"For  breakfast  I  take  four  or  five  ounces  of  beef, 
mutton,  kidneys,  broiled  fish,  bacon,  or  cold  meat  of 
any  kind  except  pork,  a  large  cup  of  tea  (without  milk 
or  sugar),  a  little  biscuit  or  one  ounce  of  dry  toast. 

"  For  dinner  five  or  six  ounces  of  any  fish  except 
salmon,  any  meat  except  pork,  any  vegetable  except 
potato,  one  ounce  of  dry  toast,  fruit  out  of  a  pudding, 
any  kind  of  poultry  or  game,  and  two  or  three  glasses 
of  good  sherry,  claret,  or  madeira — champagne,  port  or 
beer,  forbidden. 

*  "  Letter  on  Corpulence."    New  York,  1864  (fourth  edition). 


158  HALE   ON   ABORTION. 

"  For  tea  two  or  three  ounces  of  fruit,  a  rusk  or  two, 
and  a  cup  of  tea  without  milk  or  sugar. 

"For  supper  three  or  four  ounces  of  meat  or  fish, 
similar  to  dinner,  with  a  ^lass  or  two  of  claret. 

"For  night-cap,  if  required,  a  tumbler  of  grog  (gin, 
whiskey,  or  brandy  without  sugar),  or  a  glass  or  two 
of  claret  or  sherry." 

It  seems  almost  incredible  that  a  man  could  actually 
get  lean  upon  such  a  substantial,  even  luxurious,  diet. 
Yet  there  is  not  wanting  the  testimony  of  other  corpu- 
lent patients  who  have  adopted  this  method,  that  it  is 
quite  effectual  for  the  purpose,  the  mere  abstraction  of 
starch  and  sugar  arresting  the  accumulation  of  adipose 
matter.  Mr.  Banting  had  previously  tried  "sea-air  and 
bathing,  much  walking  exercise,  taken  gallons  of 
physic  and  liquor  potassse,  riding  on  horseback,  "lived 
upon  sixpence  a  day,  and  earned  it,"  if  bodily  labor  be 
so  construed,  yet  the  evil  still  increased. 

There  are  some  medicinal  measures  which  may  be 
tried  if  the  above  diet  does  not  succeed.  Liquor 
potasses  has  been  useful  in  the  removal  of  adiposis. 
This  it  is  supposed  to  do  by  saponifying  the  fatty  por- 
tions of  the  food  before  it  has  time  to  be  absorbed. 
The  dose  is  twenty  to  thirty  drops,  taken  about  two 
hours  after  meals.  Iodine,  iodide  of  potassium,  and 
some  other  drugs,  are  alleged  to  have  removed  adiposis, 
but  they  are  poisons,  and  should  not  be  used.  Acetic 
acid,  when  taken  in  the  form  of  vinegar,  is  well  known 
to  cause  a  great  decrease  in  size  in  fat  persons,  but  in 
doing  so  it  is  likely  to  deteiiorate  the  blood  to  a  serious 
degree. 

Quite  lately  a  species  of  sea- weed  known  as  ihefucus 
vesciculosus  has  been  highly  recommended  for  the  pur- 
pose of  decreasing  corpulence.  It  probably  contains, 
in  common  with  other  sea-weeds,  iodine  in  large  pro- 
portion. 


TREATMENT   OP   ABOETION.  159 

There  is  a  condition  of  general  anasa/rca  which  is 
often  mistaken  for  plethora  or  adiposis,  but  may  be  dis- 
tinguished by  a  careful  examination.  It  may  be  allied 
to  that  condition  known  as  leucocythsemia.  This  con- 
dition calls  for  such  remedies  as  potass,  tart,  etferrum,  T'7 
in  grain  doses,  aided  by  apis  met.,  apocynum  cann., 
eupatorium  pur.,  china,  and  helonias. 

Anosmia,  or  Chlorosis. — These  conditions  should  not 
be  considered  identical.  The  former  generally  proceeds 
from  direct  loss  of  blood,  of  or  some  of  the  vital  fluids 
formed  from  the  blood,  to  such  an  extent  as  to  diminish 
the  amount  of  the  circulating  fluid.  The  latter  is 
generally  a  condition  in  which  the  quality  of  the  blood 
is  deteriorated,  and  is  caused  by  deficient  assimilation 
or  depraved  nutrition.  The  origin  of  the  malady  may 
exist  in  the  digestive  organs  or  nervous  system. 

It  is  therefore  evident  that  the  same  treatment  is  not 
appropriate  for  both  conditions.  It  has  been,  and  still 
•is  to  a  certain  extent,  the  opprobrium  of  the  old  school 
of  medicine,  that  they  prescribe  ferruginous  remedies 
indiscriminately  in  both  diseases.  The  result  is  that 
only  a  portion  of  those  who  are  thus  treated  are  bene- 
fitted  by  the  medicines  used. 

In  uncomplicated  anaemia  iron  is  rarely  indicated. 
It  is  only  when  the  deficiency  of  blood  is  attended  with 
a  lack  of  certain  vital  constituents  that  this  mineral 
should  be  used.  For  true  anaemia  the  appropriate 
remedies  are  china,  helonias,  aletris,  hydrastis.  If 
chlorotic  symptoms  are  associated  with  the  anaemia, 
then  it  will  be  found  beneficial  to  alternate  with  one  of 
the  above,  ferrum  met.  or  some  of  its  preparations — I 
usually  prefer  the  pyrophosphate  of  iron — or  we  may 
use  such  compound  preparations  as  have  been  sanc- 
tioned by  experience,  whose  constituents  we  find  to  be, 


160  HALE   ON   ABORTION. 

by  their  patliogeneses,  indicated  in  the  case.  Of  this 
class  of  medicines,  the  citrates  of  iron  and  quinia, 
elixir  of  lark  and  iron,  and  some  others,  may  be  given 
with  the  best  results.  In  true  chlorosis,  the  most 
useful  remedies  are  those  which  directly  modify  the 
digestive  and  nutritive  functions,  and  increase  the  tone 
of  the  nervous  system. 

The  medicines  may  be  divided  into  three  classes : 

(a)  Jferrum  met.,  or  some  one  of  its  various  prepara 
tions.     It  has  been  observed  by  nearly  all  practical 
physicians  that  iron,  in  its  pure   state,  while  it  would 
restore   some   cases  in    a   very  short    time,  failed  to 
improve  the  condition  of  others.     But  when  used  com- 
bined with  some  acid  (as  the  phosphoric)  or  an  alkali 
(as  potash),  it  would  act  as  a  prompt  remedial  agent. 
The  reason  of  this  can  best  be  understood   by  the 
Homoeopathist,  who  finds  that  cases  not  amenable  to 
iron  alone,  but  which  improved  under  iron  and  phos- 
phoric acid  (as  phosphate  of  iron),  presented  symptoms 
which  were  not  covered   by  the  pathogenesis  of  either 
remedy  singly,  but  by  both  completely.     It  is  possible, 
even  probable,  that  the  alternation  of  the  two  medi- 
cines would  effect  the  same  curative  result;    but  if, 
when  given  in  combination,  they  cure  promptly,  we 
should  not  object  to  the  form  of  administration. 

(b)  Pfoaghopic,  Nitric,  or  Muriatic  Acids. — Of  these 
the  phoxpJioric  acid  stands  the  highest  in  the  estimation 
of  the  new  school,  probably  because  of  its  intimate 
relation  to  the  nervous  system.     Here  again,  as  with 
ferrum  met.,  we  meet  with  cases  wherein  the  acids  alone 
will  fail  to  effect  a  cure,  but  if  we  associate  with  the 
acid  indicated,  an  alkali,  or  some  other  remedy  which  is 
also  indicated,   we  speedily  remove  the  disease.     As 
examples  of  this  rule,  we  often  treat  cases  for  which 


TKEATMENT   OF   ABOETIOJT.  161 

phosphoric  add  and  calcarea  are  the  appropriate  reme- 
dies. In  such  instances  it  does  not  matter  whether  we 
give  the  phosphate  or  the  hypophosphite  of  lime,  a  cura- 
tive result  follows,  because  a  diseased  organism  will 
appropriate  to  itself  the  proper  curative  agents,  no 
matter  in  what  form  or  chemical  combination  it  is 
administered.  I  have  found  the  kali  hypophos.,  manga- 
num  hypophos.,  and  natrum  Jiypophos.,  to  be  very  useful 
in  certain  cases  of  chlorosis.  Natrum  muriaticum  is  an 
excellent  remedy  in  this  condition.  Allopathic  autho- 
rities speak  of  it  as  a  powerful  hsematogen,  in  some 
cases  nearly  equal  to  iron. 

(c)  Nux  vomica,  Ignatia,  Strychnia. — When  chlo- 
rosis depends  upon  spinal  exhaustion,  or  a  want  of  tone 
in  the  nervous  system,  then  this  class  of  remedies  are 
the  only  ones  which  will  effect  satisfactory  improve- 
ment. Dr.  Muller*  reports  many  cases  of  chlorosis 
cured  with  ignatia,  when  all  other  means  had  failed. 
The  citrate  of  iron  and  strychnia,  or  strychnia  alone, 
has  been  found  very  effectual  for  the  cure  of  chlorosis. 
The  former  preparation  is  a  favorite  one  with  me.  In 
many  cases  of  chorea,  hysteria,  and  chlorosis,  dependent 
upon  spinal  exhaustion,  it  has  effected  in  my  hands  the 
most  rapid  and  surprising  cures. 

Jahrf  gives  a  long,  list  of  .medicines  indicated  in 
chlorosis,  of  which  the  following  are  the  most  useful : 
Calcarea,  cocculus,  ferrum,  nitric  acid,  conium,  pulsa- 
tilla,  sulphur,  china,  platina,  sepia  and  sulphur,  to 
which  I  will  add  manganese,  helonias,  cimicifuga,  sene- 
cio  gracilis  and  aletris. 

In  that  analogous  disorder  known  as  leucocythemia, 
a  somewhat  different  class  of  remedies  are  indicated, 

*  North  American  Journal  of  Homreopathy,  vol.  vi.  p.  166. 

f  Diseases  of  Women. 
11 


162  HALE   ON   ABORTION. 

namely,  f  en-urn  iodatum,  ferrum  arseniosum,  and  helo- 
nias  dioica  (also  plumbum). 

I  hardly  need  add,  that  appropriate  food,  proper 
exercise,  bathing,  pure  air,  and  healthful  surroundings, 
together  with  the  removal  of  all  known  causes  of  the 
complaint,  whether  mental  or  physical,  are  as  import- 
ant as  the  most  carefully  selected  medicinal  agents. 

The  Scrofulous  Diathesis. — In  those  cases  where  we 
are  convinced  that  the  local  disorders  which  threaten 
the  life  of  the  foetus,  or  tend  to  arrest  the  progress  of 
gestation,  are  due  to  scrofulosis,  we  must  combat  the 
diathesis  with  remedies  adapted  to  each  case,  and  at 
the  same  time  prescribe  such  palliative  remedies  or 
topical  applications  as  are  indicated.  A  careful  study 
of  Hahnemann's  chronic  diseases  is  essential  to  the 
proper  treatment  of  these  cases.  The  remedies  which 
are  evidently  appropriate,  are  those  whose  local  effects 
upon  the  uterus,  as  well  as  their  general  symptoms,  cor- 
respond most  to  the  cases  under  treatment.  The  most 
prominent  of  these  are  the  well-known  anti-psorics — 
Arsenicum,  calcarea,  conium,  hepa/r  sulph.,  iodine,  lyco- 
podium,  mercuriits,  silicea,  sulphur,  to  which  may  be 
added  other  medicines  equally  efficient  but  less  used — 
Aurum  mur.,  bromine,  tistus  canad.,  graphites,  Creo- 
sote, lachesis,  sepia;  or,  bromide  of  potash,  bromide  of 
iron,  iodide  of  potash,  iodide  of  won,  iodide  of  arsenic, 
iodide  of  sulphur,  iodide  of  mercury,  chloride  of  plati- 
num, oleum  jecoris  aselli,  chimaphilla,  ms  versicolor, 
phytolacca,  rumex  crispus,  stillingia  sylvatica. 

Return  of  Menstrual  Crisis. — When,  from  previous 
habitual  dysmenorrhoea,  menorrhagia,  or  any  undue 
tendency  of  blood  to  the  uterus,  or  from  any  weakness 
or  irritability  of  that  organ,  the  menstrual  nidus 
threatens  to  be  so  great  as  to  threaten  the  continuance 


TREATMENT   OF   ABORTION.  163 

of  pregnancy,  such  remedies  should  be  selected  as  seem 
appropriate  to  each  particular  case,  and  should  be  ad- 
ministered during  the  mter-menstrual  as  well  as  the 
menstrual  period.  The  medicines  which  will  be  most 
generally  useful  are — Aleti^is  farinosa,  asclepias  syriaca, 
belladonna,  cimicifuga,  caulophyllum,  calcarea,  gos- 
sipium,  helonias,  ignatia,  platinum,  pulsatiUa,  sanguin- 
aria,  secale,  sabina,  sepia,  trillium,  senecio  gracilis, 
tanacetum ;  or  some  one  of  the  medicines  mentioned 
as  being  capable  of  causing  abortion. 

But  medicines  alone  are  not  capable  of  preventing 
the  unnatural  return  of  the  menstrual  nidus,  unless  we 
direct  the  woman  to  avoid  undue  exercise  or  warm 
baths,  stimulant  articles  of  food  or  beverages,  coition, 
or  any  mental  emotion  of  an  unusual  character,  also 
any  other  influence  which  the  physician  with  his  know- 
ledge of  the  idiosyncrases  of  his  patient,  shall  consider 
inappropriate  to  her  condition. 

Zymotic  Diseases. — In  a  work  of  this  character  and 
scope,  the  particular  treatment  of  this  class-  of  maladies 
cannot  be  entered  into.  A  mere  mention  .  is  all  that 
can  be  given  to  each  disease.  * 

(a)  Syphilis. — For  the  specific  treatment  of  this  dis- 
order the  reader  is  referred  to  those  works  which  treat 
of  venereal  affections,  among  which  may  be  mentioned 
"  Gollmann  on  Diseases  of  Sexual  Organs,"  "  Yeldham 
on  Venereal  Diseases,"  together  with  the  papers  on 
that  subject  to  be  found  in  our  journals,  etc.  The  best 
works  of  the  dominant  school  may  be  consulted,  the 
most  scientific  and  rational  of  which  is  "  Bumstead  on 
Venereal." 

There  are  certain  remedies,  however,  which  are  not 
mentioned  by  any  of  the  above  authorities,  but  which 
have  been  found  useful  in  the  treatment  of  syphilis: 
they  are, 


164  HALE   ON   ABORTION. 


formosa,  chloride  of  platina,  ins  versi- 
color,  phytolacca  dec.,  and  styllingia  syl.  In  my  own 
practice  these  last-mentioned  medicines  have  been  pre- 
scribed with  signal  advantage,  when  the  preparations 
of  mercury,  so  much  relied  upon,  were  useless  or  nearly 
so.  In  addition  to  the  above  the  biniodide  of  mercury 
and  iodide  of  potash  have  been  the  most  effectual  prepa- 
rations, which  I  have  used  in  the  treatment  of  syphilis. 

(b)  Mercurialization.  —  In  the  treatment  of  this  form 
of  drug  poisoning,  we  must  bring  to  bear  upon  the 
organism  two  forces:    namely,  the  chemical  and  dy- 
namic.    These  may  be  used  singly  or  combined.     It  is 
well  known  to  scientific  medical  men,  that  iodide  of 
potassium  actually  enters  into  chemical  combination 
with  mercury,  in  the  body  —  holds  it  in  solution,  —  in 
which  state  it  is  carried  out  of  the  system  through  the 
various  emunctories.     For  such  purpose  —  it  is  needless 
to  add  —  the  drug  must  be  administered  in  material 
quantities,  or  we  shall  fail  to  get  any  but  its  dynamic 
effects,  which  alone  are  not  sufficient  to  eradicate  the 
malady.     Chlorate  of  potash  and  hepar  sulphuris  have 
*a  somewhat  similar  effect,  but  not  to  the  same  degree. 
If  we  wish  to  obtain  a  dynamic  antidotal  effect,  or  to 
remove  certain  local  affections  caused  by  mercury,  we 
shall  find  most  useful  the  remedies  mentioned  above,  also, 
aurum  met.,  and  muriaticum,  platinum  chlor.  phyto- 
laca,  podophyUum,  nitric  acid,  iodine,  mezereum,  sulphur, 
styllingia,  iris  versicolor  lachesis. 

In  some  instances  it  would  be  well  to  advise  the  pa- 
tient to  drink  certain  mineral  waters,  etc.,  abounding 
in  sulphur,  -iodine,  and  other  well-known  antidotes  to 
the  effects  of  mercury. 

(c)  Variola.  —  The  therapeutics  of  small-pox  are  so 


TREATMENT   OF   ABOETION.  165 

well  set  forth  in  our  standard  works  on  Practice,*  that 
no  extended  treatment  will  be  given  here. 

My  colleagues,  with  whom  I  have  compared  notes  rela- 
tive to  the  treatment  of  this  disease,  give,  as  the  results 
of  their  experience,  that  aconite,  gelseminum,  or  cimici- 
fugaft  are  the  most  valuable  in  the  first  stage  of  the 
malady;  and  in  the  second,  tartai*  emetic  or  variolin. 

My  experience  in  small-pox  has  been  limited.  Two 
of  my  cases,  however,  were  of  the  most  severe  character, 
(confluent)  occurred  in  pregnant  women,  but  they  made 
a  good  recovery  without  any  threatening  of  abortion. 
They  were  treated  with  aconite,  belladonna,  vwriolin  and 
tartar  emetic. 

It  is  my  impression  that  when  abortions  are  reported 
to  have  occurred  during  an  attack  of  variola,  it  is  as 
often  due  to  the  harsh  medication,  as  to  the  disease. 
At  the  same  time  it  cannot  be  doubted  that  appro- 
priate remedies  may,  by  mitigating  the  violence  of  the 
attack,  prevent  the  occurrence  of  miscarriage.  Of  these 
remedies  none  promise  to  be  more  efficient  than  cimici- 
fuga  (or  cimicifugin^)  Having  a  specific  influence  over 
the  uterine-motor  functions,  it  prevents  the  access  of 
spasmodic  or  irritable  conditions,  which  might  other- 
wise obtain. 

In  relation  to  the  extraordinary  claims  set  forth  for 
thuja,  no  positive  testimony  has  ever  appeared  which 
in  the  least  substantiated  those  claims.  Those  who  are 
practically  acquainted  with  the  progress  of  a  varioloid, 
know  very  well  that  at  a  certain  period  of  the  disease, 
the  eruption,  which  appeared  to  be  ripening,  all  at  once 
is  arrested,  as  it  would  seem  from  some  powerful  influ- 
ence. The  pustules  suddenly  "abort,"  a  rapid  recovery 
ensues  and  no  pitting  occurs.  This  peculiar  crisis  never 

*  Marcy  and  Hunt's  Practice.        f  New  Provings,  page  106. 


166  HALE   ON   ABORTION. 

occurs  in  variola, — i.  e.,  in  persons  who  have  never  been 
vaccinated.  Now,  in  those  cases  in  which  thuja,  400th, 
is  alleged  to  have  been  given  with  such  splendid  results, 
no  mention  is  made  whether  they  were  variola  or  vario- 
loid.  This  omission  makes  the  testimony  very  unsatis- 
factory, if  not  entirely  unreliable. 

The  same  objections  would  hold  good  against  the 
claims  of  the  new  remedy,  sarracenia,  were  it  not  for 
the  fact  that  this  has  been  extensively  tested  in  cases 
which  were  undoubtedly  true  variola.  Sarracenm  is 
strongly  opposed  by  those  who  are  sceptical  of  its 
powers.  Since  the  publication  of  the  first  article  treat- 
ing of  that  plant,*  in  our  literature,  the  testimony  which 
has  appeared,  from  public  and  private  sources,  relative 
to  its  prompt  efficacy  in  arresting  the  course  of  the 
worst  forms  of  variola,  would  place  it  at  the  head  of  all 
known  remedies  for  that  virulent  malady. 

Dr.  Wilkinson,  of  England,  in  a  recent  work,f  sets 
up  extraordinary  claims  for  the  curative  virtues  of 
veratrum  viride  and  hydrastis  in  this  disease;  but  the 
same  objections  may  be  properly  urged  against  the 
alleged  value  of  those  medicines.  In  the  first,  or  febrile 
stage,  the  veratrum  v.  will  undoubtedly  alleviate  the 
intense  orgasm  of  the  circulation,  and  iu  that  way 
might  prevent  abortion.  I  do  not  think  the  claims  set 
up  for  the  hydrastis  will  ever  be  substantiated  by  posi- 
tive experience.;]; 

(d)  Scarlatina. — No  physician  who  has  witnessed  cases 
of  malignant,  or  even  severe  scarlatina,  can  doubt  its 
influence  for  evil  over  the  pregnant  uterus  and  its  con- 
tents. Although  the  cases  are  rare  where  scarlatina 
maligna  occurs  as  late  in  life  as  the  usual  child-bearing 

*  "  New  Provings,"  page  384. 

f  "  Small-pox — its  preventive  treatment,"  etc.    London. 
$  Medical  Investigator,  January,  1865. 


TREATMENT    OF   ABORTION.  167 

period,  yet  instances  have  occurred  of  abortion  from 
that  cause.  When  this  result  is  to  be  feared,  the  most 
useful  remedies  are  evidently  belladonna,  apis  mellifica, 
baptisia,  and  terebinthina. 

Several  eminent  physicians,  among  them  Dr.  Nanki- 
vel,  of  Penzance,  and  Dr.  Blair,  of  this  country,  strongly 
recommend  the  apis  mel.  as  a  valuable  remedy  in  ma- 
lignant, as  well  as  simple  scarlatina.  These  recom- 
mendations are  based  upon  successful  clinical  experience 
with  this  remedy.  By  reference  to  a  former  page  it  will 
be  seen  that  apis  has  been  alleged  to  cause  abortion. 
This,  together  with  its  well-known  action  upon  the 
kidneys,  uterus,  ovaries,  etc.,  should  commend  it  to  us 
as  an  important  remedial  agent  in  cases  of  scarlatina 
where  abortion  threatens. 

Belladonna,  when  the  abortion  threatens  from  arte- 
rial congestion,  or  spinal  paralysis ;  apis,  when  the 
phlegmonous  inflammation  extends  to  the  uterus,  and 
the  nervous  centres  are  irritated ;  baptisia,  when  a  pro- 
found typhoid  and  septic  condition  threatens;  and 
turpentine,  when  the  intestinal  or  urinary  tract  is  the 
chief  seat  of  the  excessive  irritation.  Other  analogous 
remedies — as  cimicifuga,  sabina,  caulophyllum  or  gel- 
seminum  may  be  made  use  of,  as  auxiliary  remedial 
agents. 

In  this  disease,  as  in  all  others,  of  which  mention  will 
be  made,  while  we  should  select  the  remedy  in  accord- 
ance with  the  law  of  similia,  namely, — to  correspond 
with  all  the  symptoms  and  conditions  of  the  patient, — 
we  may  select  as  an  alternate  remedy,  another  medicine 
which  has  a  special  affinity  for  the  uterus,  or,  rather, 
has  some  decided  influence  in  the  production  of  abor- 
tion, while  it  is  not  Homoeopathic  to  the  ensemble  of  the 
disease  under  treatment. 


168  HALE   ON    ABORTION. 

Diphtheria.  —  The  treatment  of  this  malady*  has  been 
so  fully  set  forth  in  the  excellent  lectures  and  mono- 
graphsf  of  my  western  colleagues,  that  I  will  only  add 
thereto  such  practical  suggestions  as  are  the  results  of 
my  own  experience. 

The  internal  or  constitutional  remedies  upon  which 
I  place  most  reliance  are  laptisia,  mercurius,  lijodatus, 
phytolacca,  and  kali  bichrornatum. 

The  topical  remedies  (which  also  act  upon  the  gene- 
ral system),  are  clilwate  of  potash,  hydrastis  canadensis, 
and  permanganate  of  potash.  I  think  the  latter  medi- 
cine was  first  used  in  diphtheria  by  myself.  My  first 
experience  with  it  was  in  ulcers  of  an  irritable  char- 
acter that  had  baffled  other  remedies  both  general  and 
local.  They  healed  kindly  under  a  local  application 
of  the  solution,  and  a  consideration  of  the  constituents 
of  the  agent  led  me  to  use  it  in  diphtheria.  I  was 
struck  with  the  prompt  curative  results  obtained.  No 
medicine  with  which  I  am  acquainted  so  soon  removes 
the  exudation,  which  does  not  return.  In  this  it  has  a 
great  advantage  over  all  others,  for  it  is  well  known 
that  the  pseudo-membrane  will  return  again  and  again 
under  ordinary  treatment  with  the  applications  in  gen- 
eral use.  Neither  does  the  exudation  extend  —  at  least 
such  has  been  my  experience. 

A  glance  at  the  chemical  character  of  the  remedy 
will  explain  its  curative  action. 

"  It  may  be  made  by  mixing  equal  parts  of  very 
finely  pulverized  deutoz-ide  of  manganese  and  chlorate  of 
potassa,  with  rather  more  than  equal  parts  of  caustic 


*  Lectures  on  Diphtheria,  by  Professor  Ludlam. 
f  Treatise  on  Diphtheria,  by  Professor  Helmutk. 
\  Parrish's  Practical  Pharmacy,  p.  525. 


TREATMENT   OF   ABORTION.  169 

We  note  that  it  contains  chlorine,  which  is  antagon- 
istic to  all  zymotic  poisons  and  septic  conditions. 
(Jhloi^ate  of  potash  and  muriatic  add  have  been  found 
the  most  useful  remedies  in  diphtheria  by  physicians 
of  the  new  and  old  schools  of  medicine.  In  the  kali 
per-manganatum  we  have  not  only  these,  but  also  man- 
ganese, which,  next  toferrum,  is  the  most  active  and 
powerful  hsematogen  known.  Not  only  this,  but  it  has 
a  sustaining  and  tonic  influence  on  the  nervous  system 
possessed  by  but  few  medicines.  The  kali  per-man- 
ganatum acts  not  only  as  a  disinfectant,  and  tonic,  but 
as  a  caustic,  and  one,  too,  which  causes  little  or  no  pain, 
no  corrosion  nor  irritation.  It  may  be  applied  in  two 
ways,  namely,  (a)  in  strong  solution  with  a  camel's  hair 
brush,  and  (b)  in  weak  solution  as  a  wash  or  gargle. 

The  maximum  strength  of  the  former  preparation  is 
ten  grains  to  one  ounce  of  distilled  or  pure  rain  water ; 
of  the  latter,  one  drachm  of  the  strong  solution  to  one 
pint  of  pure  rain  water.  No  alcohol  should  be  brought 
in  contact  with  the  drug,  as  a  few  drops  will  precipi- 
tate and  render  useless  a  large  quantity  of  the  solution. 

The  fauces  should  be  thoroughly  exposed,  and  all 
portions  invaded  by  rae  exudation  painted  over  with 
the  strong  solution ;  this  should  be  done  twice  or  three 
times  daily,  and  the  weak  solution  should  be  used  as  a 
gargle  every  three  or  four  hours.  None  need  be  given 
internally  in  addition,  as  a  sufficient  quantity  will  get 
into  the  circulation  to  have  its  constitutional  effect.  It 
must  be  understood  that  I  consider  this  medicine  to 
act  Homoeopath ically,  but  at  the  same  time  it  may  be 
said  to  act  chemically,  as  will  be  shown  in  some  future 
essay  on  this  drug.* 

*  Two  severe  cases  of  diphtheria,  treated  mainly  with  the  kali  per-man- 
ganatum, will  illustrate  its  efficiency : 
(a)  A  young  man  who  had  been  ill  with  fever  for  ten  days ;  on  the  third 


170  HALE   ON   ABOKTION. 

If  I  have  somewhat  stepped  aside  from  my  strict  task, 
namely,  the  treatment  of  diphtheria  in  adult  and  preg- 
nant women,  my  only  apology  is,  that  those  remedies 
which  have  the  greatest  mastery  over  the  disease  at 
any  age,  will  give  us  the  greatest  aid  in  the  cases  under 
consideration. 

If  premonitions  of  abortion  appear  during  the  course 
of  a  diphtheritic  attack,  we  can  appropriately  alternate 
certain  remedies,  namely,  sabina,  caulopJiyllum,  or 
cimicifuga,  etc.,  with  those  which  we  are  using  for  the 
original  malady.  The  remedies  mentioned  will  not 
retard  the  cure — in  fact  may  assist  our  treatment,  by 
their  specific  action  upon  the  diphtheria  itself,  as  well 
as  upon  the  uterus. 

Cholera. — The  Homoeopathic  treatment  of  the  differ- 
ent varieties  of  this  disease,  whether  sporadic,  as  cholera 
morbus ;  or  epidemic,  as  cholera  Asiatica,  will  be  found 
in  the  various  text-books  of  our  school,  but  especially 
in  that  admirable  monograph*  by  a  late  lamented 
Homceopathician,  Dr.  B.  F.  Joslin,  sen. 

day  I  saw  him ;  his  fauces  covered  with  a  membrane,  pearly  at  the  edges, 
yellowish  in  the  centre ;  breath  very  offensive ;  much  debility ;  pains  as  if 
beaten  all  over ;  prognosis  unfavorable.  The  weak  solution  was  used  every 
three  hours,  and  mere,  bijod.,  3rd,  used  alternately.  In  thirty-six  hours  all 
the  membrane  had  disappeared ;  strength  increasing ;  breath  not  offensive ; 
discharged  on  third  day  of  treatment. 

(J)  A  child  aged  five  years ;  two  sisters  had  died  of  diphtheria  within  a 
week ;  tonsils  coated  with  false  membrane ;  breath  offensive ;  very  weak ; 
croupy  cough,  elc.  Used  the  strong  and  weak  tincture,  alternate  with 
phytolwxa,  1st.  Cured  in  three  days. 

*  Epidemic  Cholera,  1852. 


TREATMENT    OF   ABORTION. 


SECTION    II. 

(2)  LOCAL  OR  ORGANIC. 

(1)  Malformation  of  the  Ovum. 

(2)  Malformation  of  the  Membranes. 

As  it  is  apparent  that  no  remedial  measures  can  pre- 
vent or  remove  any  malformation  of  the  ovum*  or  mem- 
branes, if  we  have  a  suspicion  that  such  an  abnormality 
exists,  our  only  method  of  preventing  abortion  from 
such  causes,  is  to  prescribe  such  remedies  as  will  tend 
to  prevent  the  uterus  from  taking  on  an  irritable  con- 
dition, or,  if  such  condition  has  already  obtained,  to 
remove  it.  In  this  way  we  may,  if  it  is  considered  de- 
sirable, conduct  the  pregnancy  to  a  termination  at  full 
time.  It  is  doubtful,  however,  if  such  a  termination 
is  to  be  desired,  for  there  are  no  dictates  of  humanity 
which  can  make  it  a  moral  duty  for  us  to  favor  the 
birth  of  a  monster,  or  deformed  child,  rather  than  its 
premature  expulsion,  unless  the  safety  of  the  mother 
is  to  be  gained  by  the  former  result.  The  medicines 
best  adapted  to  bring  about  the  uterine  sedation  men- 
tioned above,  are  belladonna,  atropine,  timicifuga, 
caulopJiyllum,  secale,  sabina,  tanacetum,  etc. 

Placental  abnormalities. — (a)  Mai-location  of  placenta 
(placenta  previa),  (b)  detachment  of  placenta.  Obvi- 
ously, no  remedy  can  prevent  the  placenta  from  locat- 

*  Croserio  (vide  Obstetrics)  intimates  that  the  administration,  to  the  mother, 
of  such  remedies  as  sulphur,  calcarea,  and  other  anti-psorics,  in  the  30th 
dilution,  will  remove  diseased  conditions  of  the  ovum.  (!) 


172  HALE   Off   ABORTION. 

ing  over  the  os  uteri,  or  any  other  portion  of  the 
surface  of  the  uterus.  But  there  are  remedies  which, 
after  the  mal-location  has  resulted  in  conditions  and 
symptoms  which  tend  to  bring  about  an  abortion,  may 
so  modify  the  condition,  and  hold  the  symptoms  in 
abeyance,  as  to  conduct  the  pregnancy  to  a  favorable 
issue  for  both  mother  and  child.  If,  when  detachment 
occurs  as  the  result  of,  or  from  falls,  blows,  or  instru- 
mental interference,  haemorrhage  occurs,  the  patient  is 
confined  to  her  bed,  kept  cool  and  perfectly  quiet,  and 
such  medicines  administered  as  wnica,  hamamelLs, 
hypericum,  i*uta,  etc.,  or  any  other  remedy  which  seems 
specially  Homoeopathic  to  the  symptoms,  we  may  be 
gratified  by  seeing  the  haemorrhage  arrested,  and  with 
it  the  pain  and  other  symptoms  subside,  and  the  patient 
ultimately  recover.  But  such  a  favorable  result  is  not 
usual.  Generally,  with  the  haemorrhage,  other  symp- 
toms, as  chills,  labor-like  pains,  etc.,  appear,  which  indi- 
cate that  the  blood  is  separating  the  membranes  from 
the  uterine  walls.  After  this  occurs,  no  remedial  agent 
can  arrest  the  abortion.  Our  sole  effort  should  be  to 
conduct  it  to  a  safe  termination. 

In  cases  of  placenta  previa,  frequent  haemorrhages 
may  occur,  as  the  uterus  expands  and  enlarges.  These 
haemorrhages  will  often  subside  spontaneously,  at  other 
times  the  loss  of  blood  goes  on  until  checked  by  appro- 
priate remedies.  In  this  form  of  haemorrhage  the  blood 
escapes  directly  into  the  vagina,  and  does  not  permeate 
between  the  membranes  and  the  uterus,  hence  the  dan- 
ger of  an  abortion  is  not  as  great. 

The  most  efficient  remedies  to  arrest  the  bleeding 
are  erigeron,  erechthites,  arnica,  Jiamamelis,  aconite,  mil- 
lefolium,  secale,  sulpk.  acid,  imlUum,  etc.,  administered 
internally.  Topically,  we  may  use  with  advantage 


TREATMENT   OF   ABORTION.  173 

pieces  of  lint  or  cotton  saturated  with  a  solution  of  any 
of  the  above  remedies,  especially  erigeron,  hamamelis, 
and  arnica.  Cold  water  will  sometimes  arrest  the 
bleeding,  when  applied  to  the  os  uteri.  Care  should 
be  taken  not  to  use  too  much  lint,  as  it  might  act  as  a 
tampon,  and  cause  the  blood  to  collect  and  flow  back, 
separating  the  membrane  in  the  process,  thus  causing 
the  very  accident  we  are  trying  to  avoid.  We  should 
also  be  careful  not  to  irritate  the  vagina  by  unneces- 
sary or  harsh  manual  efforts,  or  we  may  set  up  sufficient 
reflex  action  to  excite  uterine  contractions.  The  ex- 
ternal application  of  cold  water  to  the  abdomen  should 
be  avoided,  as  it  tends  to  the  same  result. 

ORGANIC    DISEASE    OF   PLACENTA. 

(a)  Fatty  Degeneration,  (b)  Calcareous  Degeneration. 
(<?)  Hydatid  Degeneration,  (d)  Molar  Degeneration. 

In  the  present  state  of  our  therapeutical  knowledge, 
we  know  of  no  remedy  or  remedies  which  could  prevent 
the  occurrence  of  the  above  organic  changes.  These 
diseases  of  the  placenta  probably  have  their  origin  in 
some  dyscrasia  pervading  the  blood  of  the  mother. 
This  dyscrasia  is  generally  the  psoric  or  the  syphilitic. 

The  science  of  diagnostics  has  not  reached  that  point 
where  we  can  decide  if  either  of  the  above  changes  have 
taken  place  in  the  placenta.  It  is  true  we  may  safely 
predict  the  existence  of  a  hydatid  mass  in  the  uterus, 
if  individual  hydatid  vesicles  have  been  discharged 
per  vaginum ;  but  we  cannot  safely  give  an  opinion  as 
to  the  existence  of  a  mole,  until  the  uterus  has  expelled 
it.  If  a  woman  has  had  conceptions  which  have  re- 
sulted in  such  organic  diseases,  as  was  proved  by  the 
expulsion  of  the  degenerated  mass,  we  may  fear  the 


174  IIALE   ON   ABORTION. 

occurrence  of  similar  changes  in  the  placenta,  as  a  re- 
sult of  subsequent  conceptions,  especially  if  the  symp- 
toms of  the  pregnancy  are  peculiar  and  unnatural. 

The  treatment  of  organic  diseases  of  the  placenta ;  or 
rather  the  preventive  treatment  of  abortion  from  such 
causes,  is  manifestly  obscure. 

Dr.  Tyler  Smith  says — "  When  the  foetus  is  threat- 
ened with  death  because  the  placenta  cannot  perform 
its  nutritive  and  respiratory  functions,  we  may,  through 
the  mother,  act  upon  the  placenta,  and  assist  in  the 
performance  of  its  functions."*  Dr.  Power  prescribed 
the  inhalation  of  air  containing  an  increased  quantity 
of  oxygen,  or  the  use  of  medicines  containing  a  large 
proportion  of  oxygen  in  a  loose  state  of  combination,  as 
nitric  avid,  in  cases  where  the  child  has  been  lost  re- 
peatedly in  the  latter  months  of  pregnancy.  Dr.  Simp- 
son states  that  he  has  found  chlorate  of  potash  useful  in 
cases  where  the  foetal  respiration  is  imperfect.  "  In  the 
prevention  of  abortion  from  fatty  degeneration  of  the 
placenta,"  Dr.  Smith  says,f  "the  strength  of  the  mother 
should  be  supported  in  every  way.  The  chlorate  of 
potash,  nitric  acid,  mild  preparations  of  iron,  and,  above 
all,  fresh  air,  should  be  recommended.  The  treatment 
of  fatty  placenta  should  be  the  same  as  fatty  heart,  or 
fatty  degeneration  of  any  other  organ." 

The  Homo3opathic  treatment  of  fatty  or  calcareous 
degeneration  is  yet  uncertain.  "We  know  of  no  medi- 
cines which  cause  these  organic  changes. 

If  we  suppose,  from  the  patient's  previous  history, 
and  the  present  symptoms,  that  the  placenta  is  under- 
going degeneration,  we  may  administer  medicines  for 
the  purpose  of  acting  through  the  maternal  circulation 
upon  the  diseased  organ. 

*  Lectures  on  Obstetrics,  page  201.        \  Ibid. 


TREATMENT   OF   ABORTION. 

The  anti-psorics  may  be  consulted,  for  in  that  class 
we  shall  be  most  likely  to  find  the  appropriate  remedy. 

For  fatty  degeneration,  such  remedies  as  baryta  car- 
bonica,  thuja,  kali  bromatwn  or  nitric  add,  may  be 
used. 

For  calcareous  degeneration,  we  can  suggest  no  spe- 
cific remedy ;  nor  for  the  hydatid  or  molar ;  the  general 
symptoms  of  the  patient  must  be  our  guide  in  the  selec- 
tion of  the  medicines. 

If  we  become  satisfied  that  these  organic  changes- 
have  taken  place,  it  seems  evident  to  me  that  our  duty 
should  be  to  rid  the  woman  of  them  as  soon  as  possible. 
To  this  end,  we  may  separate  the  degenerated  mass 
from  the  uterine  walls  by  the  careful  use  of  the  sound 
or  flexible  catheter,  or  by  the  injection  of  tepid  water ; 
and  in  case  of  hydatids  we  may  break  down  the  accu- 
mulation and  separate  the  mass  from  the  uterus  by  the 
same  means.  Dr.  Bedford  relates  the  case  of  a  woman 
in  extreme  danger  from  loss  of  blood,  in  which  he  suc- 
cessfully broke  down  the  hydatids  with  a  female  cath- 
eter. Dr.  Tyler  Smith  says  the  hydatids  are  sometimes 
expelled  with  difficulty,  and  he  once  saw  a  case  in  which 
the  uterus  had  been  ruptured  by  the  violence  of  its 
contractions  in  expelling  an  hydatid  mole.' 

Several  cases  of  hydatids  successfully  treated  have 
appeared  in  our  periodicals ;  one  by  Dr.  Comstock,* 
and  another  by  the  writer. f 

The  after  treatment  is  the  same  as  in  cases  of  actual 
foetal  abortion. 

*   Medical  Investigator,  vol.  ii.,  p.  10. 

f  American  Magazine  of  Homoeopathy,  vol.  1. 


176  HALE    ON   ABORTION. 


SECTION    III. 

REFLEX  (EXCITING). 

1.  CENTKIC. 

(a)  Emotions  of  Fright,  Anger,  Grief,  etc. 

We  find  in  our  repertories  the  following  remedies 
recommended  for  the  consequences  of  the  above  men- 
tioned emotions.  I  have  placed  those  in  ITALICS  which 
are  most  likely  to  be  useful  in  abortion  excited  by  such 
causes. 

ANGER. — Aconite,  bryonia,  chmnomilla,  colocynth, 
nux  vomica,  platina,  staphisagria. 

FRIGHT. — Aconite,  belladonna,  gelseminum,  hyoscia- 
mus,  ignatia,  lachesis,  opium,  pulsatilla,  sambucus,  vera- 
trum. 

GRIEF. — Ignatia,  phosphoric  acid,  hellebore. 

JOY. — Coffee,  scutellwi^ia,  cannabis  indica. 

Most  of  the  above  medicines  are  recommended 
from  general  indications,  and  no  true  Homoeopath- 
ician  would  prescribe  any  one  of  them  unless  the  gene- 
ral symptoms  corresponded  with  those  present  in  the 
attack.  If  any  other  medicine  in  our  extensive  Materia 
Medica  seems  particularly  indicated,  no  attention 
should  be  paid  to  the  emotional  cause,  which  should 
not  be  deemed  important  except  in  the  absence  of 
characteristic  symptoms. 

A  case  in  which  this  latter  condition  obtained,  once 


TREATMENT    OF   ABOETION.  177 

came  under  my  care.  In  the  absence  of  any  guiding 
symptom  of  importance,  phosphoric  acid  and  ignatia 
were  prescribed  and  prevented  the  abortion.  Disap- 
pointed love  was  the  cause  of  the  threatening  symptom. 

(b)  Direct  blows  upon  the  brain  or  spinal  cord. 

The  remedies  most  appropriate  to  meet  the  effects  of 
concussion  of  nerve  substance,  are  arnica,  conium,  cimi. 
cifuga,  cicuta,  gelseminum,  hypericum,  mercury,  nux 
vomica,  opium,  quinine,  rhus  tox,  and  sulphuric  acid. 

It  is  needless  to  give  the  special  indications  for  each 
of  the  above  remedies.  The  specific  curative  power  of 
arnica  is  well  known  to  all  practical  physicians;  it 
should  be  used  freely  externally  upon  the  portion 
which  has  received  the  injury,  and  at  the  same  time 
administered  internally ;  conium  is  indicated  more  par- 
ticularly for  the  chronic  effects  of  concussion.  Cimi- 
cifuga  will  often  be  found  very  useful,  especially  after 
concussions,  when,  with  the  uterine  pain,  severe  cepha- 
lagia  is  present  (also  quinine).  Gelseminum  is  often 
useful  when  a  condition  of  general  paralysis  of  the 
voluntary  muscles,  with  loss  of  sense,  and  blindness 
occurs. 

Hypericum  is  said  by  some  physicians,  who  have 
tested  its  virtues,  to  be  more  useful  in  injuries  to  nerv- 
ous tissues  than  any  other  medicine. 

Ignatia  and  nux  vomica  when  tetanic  symptoms  are 
feared. 

Opium,  when  we  find  sopor,  or  coma,  and  symptoms 
similar  to  apoplexy. 

Sulphuric  acid,  when  the  [only'notable  symptom  is 
sudden  and  excessive  uterine  haemorrhage. 

12 


178  HALE    ON    ABORTION. 

(c)  Medicinal,  namely — Quinine,  Nux  vomica,  Gel- 
x, /////,/////,  Ciniicifuga,  Secale,  Apis  (?)  and  others. 

If  we  know,  or  have  reason  to  suspect,  that  the  im- 
pending abortion  we  are  called  upon  to  avert  has  been 
excited  by  any  of  the  above  medicines  which  act 
through  the  nervous  centres,  we  must,  if  called  in  sea- 
son, attempt  to  empty  the  stomach  of  the  poison."  If  it 
has  already  entered  the  circulation,  we  must  use  those 
general  and  special  antidotes  which  are  at  our  com- 
mand. 

The  best  known  antidotes  against  the  immediate 
effects  of  quinine  are — Morphine,  arnica,  cimicifuga, 
ipecac,  pulsatilla,,  and  veratrum  viride. 

Nux  vomica  (Strychnia). — Administer  gelseminum 
in  appreciable  doses,  and  place  the  patient  under  the 
anaesthetic  influence  of  chloroform  until  the  spasmodic 
(tetanic)  symptoms  cease. 

Gelseminum. — Give  stimulants,  brandy,  whiskey,  and 
ammonia,  with  nux  vomica,  or  arnica. 

Cimicifuga. — The  antidotes  of  the  black  cohosh  are 
atropine,  opium,,  and  secale,  in  minute  quantities. 

Secale. — For  the  effects  of  ergot  on  the  uterus,  I  have 
found  caulophyllin  and  atropine  excellent  antidotes. 

Apis  mel. — Ammonia,  in  stimulant  doses,  is  the  best 
medicine  to  ward  of  the  bad  effects  of  the  bee-poison 
upon  the  nervous  centres. 

II.  CONCENTRIC. 

(a)  Parotidean  Irritation. 

By  referring  to  a  former  page  of  this  work,  it  will 
be  seen  that  in  one  case  at  least  parotitis  was  a  cause 
of  abortion.  To  prevent  such  a  result  from  metastasis 
of  mumps,  we  should  prescribe  about  the  same  remedies 


TREATMENT    OF   ABOKTION.  179 

as  in  case  of  threatened  ovaritis  or  orchitis  from  the 
same  disease,  namely,  apis  met.,  belladonna,  pulsatilla, 
or  mercury.  The  two  in  Italics  are  probably  the  most 
useful,  and  would  be  indicated  in  the  metastasis  re- 
ferred to. 

(b)  Thyroidal. — If  the  reflex  irritation  which  has 
located  in  this  gland  has  been  diverted  from  it  to  the 
uterus,  directly  or  through  the  mammae  or  ovaries,  the 
remedies  to  be  mentioned  hereafter  will  be  indicated. 
The  treatment  of  goitre  with  external  applications  of 
iodine,  mere,  bin.-iod.,  or  bromine,  should  be  suspended 
during  pregnancy,  and  small  doses  of  these  remedies 
used  instead.     These  minute  doses,  while  they  do  not 
divert  the  irritation,  act  as  a  sedative  or  palliative  to 
it,  and  really  prevent  such  irritation  from  impinging 
upon  the  uterus.     If  uterine  pain,  etc.,  has  already  set 
in,  we  must  select  the  remedy  in  accordance  with  the 
general  principles  of  our  school  of  medicine.      This 
latter  observation  will  apply  to  all  the  following  causes, 
and  need  not  be  hereafter  repeated. 

(c)  Mammary. — If    abortion   or    premature   labor 
threatens  from  prolonged  lactation,  the  child  should  be 
immediately  taken  from  the  breast,  and  lotions  of  bella- 
donna, aconite,  or  camphor,  applied  to  the  glands,  to 
arrest  the  secretion  of  milk  and  subdue  the  existing 
irritation.     If  the  cause  be  mammary  abscess,  the  same 
lotions  should  be  applied,  also  phytolacca,  which  is  an 
admirable  remedy  in  this  affection.     At  the  same  time 
belladonna,  apis,  phosphorus,  or  phytolacca,  should  be 
administered  internally.     If  these  agents  do  not  bring 
about  speedy  resolution,  and  suppuration  is  inevitable, 
place  the  patient  (if  she  is  nervous  and  sensitive)  under 
the  influence  of  chloroform,  and  open  the  abscess,  after 
which  apply  soothing  applications,  such  as  calendula,  or 


180  HALE   ON   ABORTION. 

poppy  leaves,  or  lotions  of  aconite,  calendula,  or  liama- 
mdi$.  The  pathogenesis  of  cimicifuga  seems  to  inti- 
mate that  it  may  be  useful  in  abortion  from  mammary 
irritation. 

Scanzoni  causes  premature  labor  by  applying  dry 
cups  to  the  mamnise.  Dr.  Bedford  admits  that  abor- 
tion may  be  caused  by  irritating  these  glands ;  yet  we 
are  told  by  some  late  medical  writers  that  habitual 
abortion  or  sterility  may  be  prevented  by  applying  a 
child  to  the  breast  during  the  period  when  the  usual 
menstrual  crisis  returns ! 

We  are  even  advised  by  certain  obstetric  authorities 
to  apply  the  child  early  to  the  breast,  in  order  to  avert 
a  metritis,  uterine  congestion  after  confinement,  or 
puerperal  fever. 

It  would  seem  by  the  above  that  mammary  irritation 
acts  both  as  a  cause  and  as  a  preventive  of  abortion  and 
uterine  irritation. 

Would  it  not  be  proper  and  useful  then,  in  cases  of 
threatened  miscarriage,  to  apply  mildly  irritating  sub- 
stances to  the  mammae  ?  Weak  sinapisms  of  mustard, 
capsicum,  or  arnica,  a  dry  cup  to  each  breast,  or  even 
a  warm  emollient  poultice,  might  divert  the  irritation 
from  the  uterus  to  these  organs,  and  thus  avert  the  loss 
of  the  embryo,  or  a  premature  labor. 

(d)  Dental. — If  we  have  to  treat  a  merely  functional 
disorder  of  tlie  trifacial  nerves,  or  any  nerve  branches 
which  supply  the  teeth,  the  remedies  will  be  mainly, 
aconite,  belladonna,  atropine,  china,  quinia,  valeinanate 
of  zinc,  coccionella,  geheminum,  arsenicum,  spigelia,  and 
pulsatilla. 

If  the  affection  is  organic,  namely,  carious  teeth,  the 
remedies  most  likely  to  palliate  the  pain  and  reflex 
irritation,  when  given  internally  are  mercwrius,  nitric 


TREATMENT    OF    ABORTION.  181 

acid,  antimony,  kali  hyd.,  pliospTioi^us,  manganese,  or 
those  above  mentioned. 

The  repertories  decree  that  for  "  odontalgia"  in  preg- 
nant women,  we  should  give  belladonna,  calcarea,  man- 
ganese, nux  moscfiata,  nux  vomica,  pulsatilla,  sep$a,  etc. 

We  are  cautioned  against  the  extraction  of  carious 
teeth  -during  pregnancy.  But  in  many  cases  the  irri- 
tation caused  i^so  intense,  and  so  intractable  to  medi- 
cinal treatment,  that  it  is  better  to  risk  the  operation. 
By  the  aid  of  chloroform,  however,  we  can  generally 
extract  the  tooth  and  avoid  the  risk  of  abortion  from 
the  irritation  attendant  on  the  operation.  If  it  should 
be  objected  to,  or  feared,  we  may  resort  to  topical, 
palliative  measures,  such  as  cotton  wet  with  aconite, 
gelseminum,  or  opium,  and  applied  to  the  exposed 
nerve ;  or  we  may  use  toeosote  in  the  same  manner.  I 
have  often  used  with  permanent  benefit  a  plugging 
composed  of  aconite,  chloroform  and  copal,  which 
formed  a  solid,  impervious,  and  lasting  compound.* 

The  usual  operation  of  filling,  plugging,  etc,  of  the 
dentist,  need  not  be  deferred,  unless  we  have  special 
reasons  for  so  doing. 

Odontalgia  is  often  accompanied  by  inflammation  of 
the  buccal  cavity,  stomatitis,  gingivitis,  and  other 
diseases  of  the  mouth,  nearly  all  of  which  will  subside 
under  the  specific  curative  action  of  chlorate  of  potash, 
used  in  the  form  of  a  lotion.f 

Ulcerative  affections  of  the  teeth  demand  the  same 
remedies  advised  for  pain  in  carious  teeth,  and  in  addi- 
tion, hepar  sulph.  and  phytolacca.  It  is  better  to  ex- 
tract the  tooth  than  to  allow  the  abscess,  if  deep,  to  go 

*  3     Aconite  tincture,   3j  f  ^     Chlorate  of  potash,  grs.  x. 

Chloroform,          3j  Water,  §4 

Gum  copal,    grs.  x. 


182  HALE    ON    ABORTION. 

on  to  suppuration  with  the  intense  suffering  which  some- 
times accompanies  it. 

(e)  Gastric. — The  variety  of  gastric  irritation  which 
usually  causes  abortion,  is  obstinate  and  excessive  vom- 
iting. This  may  begin  at  or  before  the  sixth  week, 
and  continue  until  the  period  of  confinement.  It  is  not 
only  often  obstinate,  but  intense  and  painful,  and  even 
accompanied  with  severe  gastric  irritatiw,  simulating 
acute  gastritis,  or  ulceration.  I  have  seen  patients, 
victims  to  this  disorder,  who  became  debilitated  and 
emaciated  to  the  last  degree  from  the  inability  to  retain 
the  least  food  or  beverage  upon  the  stomach.  The 
vomiting,  in  such  cases,  was  accompanied  by  the  most 
distressing  pyrosis,  burning  pain  in  the  stomach,  and 
spasmodic,  empty  retching,  or  with  the  ejection  of 
bloody,  grumous  matters,  and  even  pure  blood.  But 
it  is  a  strange  fact,  that  even  in  these  cases  of  extreme 
severity,  pregnancy  will  sometimes  go  on  uninfluenced, 
and  confinement  occur  at  its  proper  period.  In  other 
instances,  however,  less  severe,  and  even  quite  mild, 
abortion  will  occur,  apparently  from  no  other  cause 
than  the  efforts  at  vomiting. 

Tyler  Smith  says — "Women  who  have  undertaken 
sea-voyages  during  pregnancy,  have  died  from  the  com- 
bined effects  of  sea-sickness  and  the  vomiting  of  preg- 
nancy. In  the  worst  cases,  women  who  are  not 
relieved,  or  who  do  not  abort,  perish  slowly  from  starv- 
ation, or  they  die  from  the  rupture  of  a  blood-vessel, 
convulsions,  or  exhaustion,  after  violent  and  continued 
fits  of  vomiting."  It  is  in  these  severe  cases  that  it  is 
proper  and  humane  to  arrest  the  suffering  of  the  patient 
by  inducing  an  abortion  by  artificial  means ;  but  of  this 
we  shall  speak  further  on. 

This  affection,  which,  at  first  sympathetic,  or  reflex, 


TREATMENT   OF    ABORTION.  183 

often  becomes  a  local  disease,  is  quite  amenable  to 
Homeopathic  treatment.  In  the  simplest  form,  namely : 
morning  vomiting — a  dose  of  nux  vomica  or  podophyl- 
lum  in  the  evening,  with  ipecac  or  cimicifuga  in  the 
morning  before  rising,  will  often  palliate,  if  not  cor- 
rect the  symptoms.  When  the  vomiting  occurs  after 
meals,  and  the  food  is  ejected, — pulsatilla,  nux  vomica, 
iris  v.  or  fermm.  If  the  vomiting  occurs  at  all  pe- 
riods, and  is  aroused  by  the  least  food  and  drink — 
arsenicum,  eupJiorbia  cor.,  veratrum  alb.,  orviride,  Jcreo- 
sote,  sanguinaria  and  oxalate  of  cerium  are  useful.  Of 
these,  arsenicum  and  sanguinaria  are  indicated,  if  there  is 
great  thirst  and  burning  pain  in  the  stomach,  vomiting 
of  bloody  mucus,  etc. ;  veratrum  and  arsenicum,  if  the 
prostration  is  excessive :  kreosote  has  been  found  almost 
specific,  by  the  old  school,  in  many  severe  cases — in 
minute  doses,  it  has  been  found  useful  by  physicians  of 
the  Honioaopathic  school.  The  oxalate  of  cerium,  first 
recommended  by  Professor  Simpson,  I  have  prescribed 
with  great  benefit  in  the  first  decimal  trituration  in 
some  very  severe  and  obstinate  cases. 

Other  remedies  have  occasionally  been  used  with  suc- 
cess when  ordinary  remedies  fail.  Among  them  are — 
tincture  of  aconite,  in  drop  doses;  Colombo  and  wild 
clierry,  in  infusion ;  chloroform,  five  or  ten  drops  in  a 
spoonful  of  mucilage  ;  nitrate  of  bismuth,  when  the 
acidity  and  epigastric  pressure  is  excessive ;  salicine, 
helonias  and  nitric  acid,  "  if  the  stomach  be  in  an  atonic 
condition." 

(/)  Rectal. — The  rectal  causes  of  abortion — namely, 
dysentery,  haemorrhoids,  etc.,  have  been  described. 

The  remedies  which  have  been  found  most  useful  in 
dysentery  are — aloes,  aconite,  baptisia,  colocynth,  ipecac, 
iris  versicolor,  mercurius,  nux  vomica,  podophyllum. 


184  HALE    ON    ABORTION. 

Those  in  Italics  would  be  most  applicable  in  cases 
when  abortion  was  threatening,  in  consequence  of  the 
sympathetic  or  reflex  irritation.  If  no  one  of  the  above 
remedies  covered  the  ensemble  of  the  symptoms,  some 
other  remedy  not  capable  of  causing  dysentery  may  be 
alternated  with  the  one  selected  out  of  the  above  list. 
Thus,  aconite  and  caulophyllum,  or  colocynth  and  aletris 
could  be  alternated.  The  symptoms  of  sabina,  however, 
cover  nearly  the  whole  ground,  for  that  medicine  not 
only  causes  abortion,  with  inflammation  of  the  urinary 
organs,  but  it  has  enteritis  and  dysentery,  bloody  stools, 
etc.,  among  its  pathogenetic  effects.  Asarum  euro- 
peum,  which  causes  abortion,  has  been  found  very  use- 
ful in  acute  dysentery.  The  same  is  true  of  turpentine. 
These  last  remedies  should  not  be  forgotten  when  we 
are  called  to  treat  this  disease  in  pregnant  women. 

The  topical  treatment  of  dysentery  during  pregnancy 
should  not  be  omitted.  By  applying  some  medicine 
locally  to  the  rectum,  and  causing  a  sedation  of  its 
nerves,  we  shall  also  calm  the  irritated  nerves  of  the 
uterus.  The  remedies  best  calculated  to  subserve  this 
end  are — aconite,  gelseminum,  hamamelis,  opium,  mor- 
phine, atmpin.  These  medicines  may  be  added  to 
mucilaginous  preparations,  starch- water  or  pure  water, 
in  proper  proportions,*  and  thrown  into  the  rectum, 
where  it  should  remain.  I  am  confident  that  I  have  in 
one  instance  prevented  abortion  by  the  use  of  an  enema 
of  ten  drops  of  gelseminum  to  one  ounce  of  starch-water; 
and  in  another  prevented  a  premature  labor  by  the  use  of 
half  a  grain  of  crude  morphine  in  two  ounces  of  pure 
water.  In  each  case  the  severe  labor-like  pains  ceased  in 

*  Aconite,  Gelseminum,   o  ,  10  drops  to  one  ounce  of  water. 
Opium  Tine.,   o  (Laudanum)  20  drops  to  one  ounce  of  water. 
Hamamelis,  o  .  1  drachm  to  one  ounce  of  water. 
Morphine,  l-10th,  Atropin,  2d,  two  or  three  grains  to  one  ounce. 


TREATMENT   OF  ABORTION.  185 

half  an  hour  after  the  enema  was  given.  In  some  cases 
a  suppository  of  one  grain  of  pure  opium,  introduced 
into  the  rectum,  will  have  a  prompt  effect  in  calming 
the  tenesmus  and  labor-like  pains. 

In  case  the  uterine  irritation  proceed  from  hemor- 
rhoidal  inflammation,  the  following  remedies  will  be 
found  applicable : 

Aconite,  aloes,  belladonna,  cesculus  hip.,  collinsonia, 
hamamelis,  iris  versicolor,  mercurius,  nitric  acid,  nux 
vomica,  podophyllum,  sulphur,  turpentine. 

In  this  disease,  as  in  dysentery,  local  applications 
should  not  be  neglected.  Lotions  or  cerates*  of  afro- 
pine,  hamamelis,  or  opium,  may  be  applied  to  the  in- 
flamed and  protruded  tumors,  and  the  patient  advised 
to  assume  and  maintain  the  recumbent  position,  until 
the  local  and  reflex  irritation  has  subsided. 

Fissure  of  the  anus,  one  of  the  most  painful  and  in- 
tractable local  affections  with  which  we  have  to  deal, 
has  been  known  to  cause  abortion.  The  reflex  disturb- 
ance which  this  apparently  insignificant  lesion  can  pro- 
duce, is  quite  astonishing.  The  remedies  Homoeopathic 
to  this,  are  ignatia,  nitric  acid,  plumbum,  arsenicum, 
sulphur,  etc.  The  most  notable  cures  have  been  made 
with  nitric  acid,  30th,  and  ignatia,  30th.  I  have,  how- 
ever, cured  two  severe  cases — one  in  a  pregnant  woman, 
with  nitric  acid  and  ignatia  (at  the  3rd  dilution).  An 
enema  of  nitric  add  was  used  at  the  same  time  with 
the  internal  treatment.  (Ten  drops  of  nitric  acid 
[dilute  acid]  was  added  to  four  ounces  of  water.) 

Diarrhoea. — That  variety  capable  of  causing  miscar- 
riage, will  be  best  met  by  such  remedies  as  arsenicum, 

*  Cerate  of  Atropine,  1  grain  to  1  ounce, 
Opium,  10  grains  to  1  ounce, 
Hamamelis,  1  drachm  to  1  ounce. 


186,  HALE    ON    ABORTION. 

euphorbia  cor.,  ipecac,  iris  versicolor,  mercurius,  podo- 
phyllum,  cuprum,  pulsatilla,  sulphuric  acid,  veratrum 
album,  and  veratrum  viride. 

Constipation,  or  "functional  impediment  of  the 
bowels,"  should  be  relieved  by  the  most  prompt 
and  efficient  measures.  In  order  to  effect  this,  pur- 
gatives should  never  be  resorted  to,  for  they  will 
only  intensify  the  difficulty,  and  aggregate  the  ten- 
dency to  uterine  irritation.  The  diet  of  the  patient 
should  be  made  as  laxative  as  possible.  The  free  use 
of  fruits,  corn  bread,  cracked  wheat,  berries  (particu- 
larly whortleberries)  should  be  urged,  and  one  of  the 
following  remedies  prescribed,  namely,  arsenicum,  bry- 
onia,  collinsonia,  mercurius,  nux  vomica,  plumbum,  pla- 
tina,  lycopodium,  and  sulphur. 

The  persevering  use  of  enemas  are  particularly  re- 
commended. They  may  be  composed  of  pure  water, 
or  water  holding  in  solution  common  salt,  ox-gall,  soap, 
or  molasses — in  quantities  not  sufficient  to  be  stimulat- 
ing. Decided  benefit  has  resulted  from  enemas  medi- 
cated with  small  quantities  of  nux  vomica,  or  some 
other  medicine  Homoeopathic  to  the  local  condition 
of  the  intestines.  If  violent  purgatives  are  the  cause 
of  the  symptoms  of  abortion  we  are  called  to  treat, 
they  are  to  be  met  by  the  same  means  advised  for  the 
relief  of  a  dysentery  or  diarrhoea. 

(g)  Vesical. — The  causes  of  abortion  which  emanate 
from  the  urinary  organs  are  not  unimportant,  and  any  un- 
usual irritation  of  the  bladder  or  urethra,  during  preg- 
nancy, should  be  met  with  prompt  remedial  treatment. 
The  kidneys  are  not  so  powerful  to  originate  reflex 
irritation  as  the  other  portions  of  the  urinary  tract. 

Acute  cystitis  calls  for  cannabis,  cantharis,  apis,  aco-. 
nite,  senecio  aureus,  mercurius,  pulsatilla,  and  turpen- 


TREATMENT    OF   ABORTION.  187 

tine  (European  physicians  estimate  highly  the  curative 
powers  of  pareira  brava,  and  buchu,  in  this  affection). 

Chronic  cystitis  demands  copaiva,  chimaphilla,  erig- 
eron,  erechthites  cubeba,  thuja,  turpentine,  eupatorium 
purpureum,  and  hydrastis. 

Nephritis,  and  urethritis,  acute  and  chronic,  demand 
the  same  remedies.  For  special  indications,  refer  to 
"  Materia  Medica,"  "  New  Remedies,"  etc.  The  free 
use  of  diluent  and  mucilaginous  drinks  should  not  be 
omitted,  as  they  greatly  aid  the  action  of  specific  reme- 
dies. Among  the  most  useful  of  these  semi-medicinal 
agents,  are  ulmus  fulva  (slippery  elm),  galium  apar- 
ine  (cleavers),  Althcece  off.  (marsh  mallows).  These 
should  be  prepared  in  simple  infusion  with  cold 
or  warm  water,  and  drank  ad  libitum,  or  in  given 
quantities  (as  a  wine-glassful),  at  given  intervals,  alter- 
nately with  the  medicinal  remedies. 

(h)  Vaginal. — The  causes  of  abortion  originating 
in  the  vagina,  are  acute  and  chronic  inflammation, 
malignant  disease,  and  granular  vaginitis. 

Acute  vaginitis,  occurring  during  pregnancy,  is  an 
important  disease.  West  has  known  it  to  extend  to 
the  uterus,  producing  metritis.  The  swelling,  heat, 
pain,  and  irritation,  have  been  known  to  form  an  excit- 
ing cause  of  miscarriage.  When  attended  with  pru- 
ritus of  the  vulva,  it  is  a  most  distressing  affection,  pro- 
ducing intense  irritability  of  the  nervous  system.  This 
latter  symptom  generally  attends  an  aphthous  con- 
dition of  the  vulva  and  vagina.  The  disagreeable  itch- 
ing is  felt  not  only  in  the  vulva,  but  in  the  internal 
organs. 

The  treatment  of  vaginitis  (simple  acute)  consists  in 
the  internal  administration  of  cantharis,  cannabis,  mer- 
curius,  pulsatilla,  thuja,  sabina,  and  such  auxiliary 


188  HALE   ON   ABORTION. 

measures  as  cool  hip  baths,  emollient  and  soothing  ene- 
mata.  The  injections  which  I  have  found  most  useful 
are  infusions  of  flaxseed,  poppy-leaves,  calendula  flowers, 
and  slippery  elm.  There  are  other  forms  of  vaginitis 
which  require  different  medicines.  In  the  erysipe- 
latous,  or  erythematous  variety,  when  the  inflammation 
extends  to  the  cellular  tissue,  with  extensive  swelling, 
and  even  suppuration,  it  will  be  necessary  to  give 
belladonna,  apis,  coccionetta,  Tnercurius,  collinsonia,  can- 
tharis, and  aconite. 

Granular  vaginitis  requires  mercurius,  phytolacca, 
sabina,  and  cantharis. 

Vesicular  vaginitis — rhus  tox,  commocladia,  petroleum, 
cantharis,  croton  tig.,  and  dulcama/i*a;  and  the  pustular 
variety — tartar  emetic,  and  sabina.  The  gonorrlio&al 
has  been  mentioned  under  that  head,  and  the  chronic 
under  "  Leucorrhcea." 

If  pruritus  attends  either  of  the  above  varieties,  some 
one  of  the  above  medicines  will  be  indicated,  especially 
cantharis,  sabina,  collinsonia,  or  platina,  but  topical  ap- 
plications cannot  safely  be  dispensed  with.  For  the  relief 
of  this  distressing  symptom  we  have  not  found  anything 
so  useful  as  the  "  lotion  of  borax  and  morpJiia,"*  applied 
to  the  vulva,  or  used  as  a  vaginal  injection — one  ounce 
every  six  hours.  Dr.  Westf  says,  "  nothing  relieves  the 
pruritus  which  accompanies  the  decline  of  vaginitis  more 
than  goulard  water  and  hydrocyanic  acid,  in  the  pro- 
portion of  two  drachms  of  the  latter  to  eight  ounces  of 
the  former."  These  applications  might,  with  some 
reason,  be  objected  to,  if  the  disease  occurred  in  the 
unimpregnated  state ;  but  when  we  wish  to  alleviate 

*  Sodse  Sub-boracis     3  ix,  f  Diseases  of  Females,  p.  480. 

Morphia  Sulph.,  gr.  viii., 
Aqua  Rosse  3  x. 


TREATMENT   OF   ABORTION.  189 

promptly  a  symptom  likely  to  result  in  serious  conse- 
quences, we  must  not  adhere  too  strictly  to  purely 
Homoeopathic  remedies,  given  internally.  Other  appli- 
cations may  be  found  useful,  such  as  aconite-water, 
eupat.  arom.,  hamamelis,  chloroform-vapor. 

Vaginismus  is  most  successfully  treated  by  the  ad- 
ministration of  gelseminum,  belladonna,  atropin,  Jiyosci- 
amus,  ignatia,  or  platinum.  This  symptom  is  gener- 
ally found  in  hysterical  women,  and  the  remedies  used 
for  that  condition  wrill  be  useful.  Injections  of  water, 
medicated  with  one  of  the  above  remedies,  will  aid  the 
cure,  or  a  soft  cerate,  in  which  they  are  incorporated  in 
proper  proportion,*  is  sometimes  still  better.  If  the 
vaginal  irritation  has  been  mechanical,  remove  the 
'source  of  irritation,  and  use  mucilaginous  injections,  or 
enemas  of  aconite,  hamamelis,  opium  or  arnica,  in  the 
proportion  of  one  drachm  to  one  pint  of  water. 

Hysterical.  —  This  condition  of  the  system  may 
be  kept  in  abeyance,  and  the  attacks  warded  off  or 
palliated  by  the  use  of  aconite,  gelseminum,  afoopine, 
ignatia,  platinum,  cimicifuga,  caulophyllum,  nux  mos- 
cJiata,  ambergris,  zincum  val.t  scutellaria,  or  cypripe- 
dium,  also  the  use  of  remedies  calculated  to  remove  the 
pathological  state  upon  which  the  hysterical  irritation 
depends. 

Epilepsy,  though  generally  incurable,  may  be  pal- 
liated by  atropine,  hyosciamus,  belladonna,  stramonium, 
zincum  phos.,  and  many  other  remedies  mentioned  in 
our  Materia  Medica  and  late  Journals.f 

Falls,  Jumping,  Blows,  etc. — These  accidents,  when 

*  Gelseminum  (tine.)  3  i  to  §  i 
Belladonna  (ext.)  3  i  to  |  i 
Atropin,  gr.i  to  §  i. 

f  North  American  Journal  of  Homoeopathy,  vol.  12,  p.  261. 


190  HALE   ON   ABOKTION. 

acting  as  concentric  causes  of  abortion,  require  about 
the  same  remedies  as  when  acting  centrically. 

If  the  patient  receive  a  blow,  or  has  a  fall,  and  the 
injury  is  followed  by  any  pain  or  soreness  in  the  uterine 
region,  or  flow  of  blood  from  the  vagina,  she  should  be 
required  to  assume  the  recumbent  position,  and  enjoined 
to  keep  very  quiet.  At  the  same  time  we  should  pre- 
scribe arnica,  rhus  tox,  liamamelis,  sulphuric  acid,  cin- 
namon, erigeron,  or  caulophyllum,  as  the  nature  of  the 
case  and  symptoms  demand.  Allopathic  physicians 
place  much  reliance,  in  cases  of  impending  abortion 
from  injuries,  upon  the  free  use  of  morphine.  They 
prescribe  a  "  full  dose,"  from  one-eighth  to  half  a  grain. 
or  more,  if  the  nervous  excitement  is  great.  This  treat. 
ment  is  not  more  at  variance  with  strict  Homoeopathic 
practice,  than  is  the  administration  of  morpliine  after 
fractures  or  severe  surgical  operations.  It  deadens  sen- 
sation, relieves  pain  and  excitement,  paralyzes  the  mo- 
tor actions  of  the  womb,  and  places  the  system  in  such 
a  condition  (in  splints,  if  the  phrase  is  allowed),  that 
the  injury  is  powerless  to  excite  the  amount  of  reflex 
irritation  necessary  to  cause  abortion.  I  have  never 
resorted  to  morphine  but  in  one  instance,  and  the 
patient  escaped  a  miscarriage ;  in  all  others,  I  have 
relied  upon  other  remedies,  with  varying  success. 


TREATMENT  OF  ABORTION.  191 


SECTION    IV. 

FUNCTIONAL 'DISEASES    OF   THE   UTERUS. 

Congestion  of  the  Uterus. — The  treatment  of  this 
condition  will  depend  on  the  nature  of  the  congestion, 
whether  acute  or  chronic.  The  remedies  recommended 
in  the  Kepertories  for  "  congestion  of  blood  to  the  ute- 


rus" are 


Belladonna,  bryonia,  china,  crocus,  hepar  sulph.,  mer- 
curius,  nux  vomica,  platina,  sabina,  secale,  sulphur. 

Of  these,  belladonna,  crocus,  sabina  and  secale,  are 
the  most  likely  to  be  indicated  in  abortion  from  this 
cause. 

But  there  are  other  remedies  equally  important  in 
the  treatment  of  congestion  and  its  consequences.  It 
should  be  borne  in  mind  that  any  remedy  capable  of 
causing  abortion,  will  cause  congestion  of  the  uterus. 
We  have,  therefore,  a  large  number  of  remedies  from 
which  to  choose. 

For  acute  congestion  the  following  are  the  most  effi- 
cient— veratrum  viride,  sabina,  belladonna,  cimicifuga, 
secale,  caulopfiyllum,  tanacetum,  aletris,  mitchella  and 
terebinth. 

For  chronic  congestion — china,  sepia,  platina,  secale, 
sulphur,  trillium,  nux  vomica,  helonias,  murex,  ferrum 
and  calcarea. 

In  peculiar  cases,  sabina,  cimicifuga,  aletris,  tanace- 
tum and  terebinth,  may  be  Homoeopathic  in  chronic 
(passive)  engorgements  of  the  womb,  by  virtue  of  their 
secondary  action. 


192  HALE   ON   ABORTION. 

Engorgement,  Induration  or  Hypertrophy  of  the  neck 
of  the  womb,  like  congestion  of  the  body  of  that  organ, 
may  be  acute  or  chronic.  In  cases  of  simple  engorge- 
ment, without  ulceration,  abrasion,  or  osdema,  we  shall 
find  the  following  remedies,  aided  by  enemas  of  cool 
aconite-water,  or  calendula-water  quite  sufficient  for  its 
removal — belladonna,  cimicifuga,  mitchella,  platina, 
sabina  and  aquaphobin. 

In  induration  or  chronic  inflammation,  we  shall  find 
most  useful — sepia,  murex,  platina,  mercurius  iod.,  kali 
brom.,  kali  liydriod,  conium,  china,  sulphur,  helonias, 
stillingia,  and  many  others. 

For  osdematous  engorgement,  or  hypertrophy,  the 
the  most  appropriate  remedies  are — arsenicum,  conium, 
apis  mel.  arnica  sepia,  iodine,  china,  helonias,  etc. 

The  internal  treatment  of  the  last  two  conditions  of 
the  cervix,  may  be  materially  assisted  by  the  topical 
use  of  the  same  medicines,  but  especially  arnica,  iodine, 
conium,  bromide  of  potash  and  china.  These  may  be 
used,  largely  diluted,  as  enemas,  or  in  some  cases  the 
stronger  preparations  may  be  applied  to  the  cervix,  by 
means  of  a  soft  brush. 

LeucorrJioxi. — The  treatment  of  this  affection  depends 
so  much  on  the  character  of  the  discharge,  the  patholo- 
gical condition  to  which  it  owes  its  origin,  and  the 
symptoms  with  which  it  is  attended,  that  it  is  absolutely 
necessary  the  physician  should  consult  his  Materia 
Medica,  or  some  elaborate  work  like  Jahr  on  Diseases  of 
Women.  It  would  not  be  proper,  in  a  work  like  this, 
to  enter  fully  into  the  special  indications  of  each  rem- 
edy. The  best  that  can  be  done  is  to  designate  those 
remedies  which  will  be  found  most  useful  in  the  varie- 
ties of  the  disorder. 

In  mucous  or  cervical  leucorrhoea,  or  that  variety 


TREATMENT    OF   ABOETION.  193 

which  is  secreted  by  the  mucous  follicles  of  the  cervix 
uteri,  the  most  appropriate  remedies  are — 

In  acute  cases — -pulsatilla,  senecio  gracilis,  sdbina, 
mercurius,  bovista,  cantharis,  podophyllum,  dulcamara, 
senega,  kali  hyd. 

In  chronic  cases  — pulsatilla,  stannum,  sulphur, 
C07iium,  sepia,  copaiva,  mere,  iod.,  kali  bromatum,  phy- 
tolacca,  trillium,  thuja,  calcarea  carl). 

In  cases  when  the  discharge  has  produced  abortion 
or  erosion  of  the  os  uteri — nitric  acid,  mere.  cor.,  mere, 
iod.,  kali  hyd.,  kali  brom,  arsenicum,  lachesis,  phospho- 
ris,  sabina.  (See  Ulceration  of  Os  Uteri.) 

Where  there  is  anaemia  or  debility — china,  helonias, 
ferrum,  manganese,  hydrastis,  aletris,  phosphoric  acid, 
and  the  hypo-phosphites. 

In  cases  of  chronic  cervical  leucorrhoea,  it  is  useful 
and  proper  to  use  topical  applications.  Any  remedy 
Homoeopathic  to  the  disorder  may  be  applied  locally  to 
the  canal  of  the  cervix,  by  means  of  a  syringe  of  pecu- 
liar shape,  and  with  the  result  of  hastening  the  cure. 
Those  caustic  substances  which  act  Homceopathically 
upon  diseased  surfaces  may  be  applied  in  the  above 
manner,  or  by  means  of  a  brush,  or  even  in  substance. 
Of  these  the  most  useful  are  argentum  nit.,  kali  per- 
manganatum,  and  nitric  acid.  The  topical  treatment 
here  advised  is  not  to  be  used  during,  but  previous  to 
pregnancy. 

The  treatment  of  a  leucorrhoea  should  be  conducted 
upon  the  same  general  principles  as  an  acute  coryza, 
or  catarrh  of  the  air  passages,  or  profuse  secretion  from 
glandular  or  mucous  surfaces.  It  will  be  noticed  by 
the  careful  student  of  Materia  Medica,  that  any  remedy 
capable  of  causing  a  peculiar  mucous  discharge  from 
the  nose,  is  capable  of  causing  a  similar,  or  even  iden- 
13 


194  HALE   ON   ABORTION. 

tical  discharge  from  the  bronchia,  bladder,  intestines, 
and  cervical  canal  of  the  uterus.  If  the  discharge  from 
the  nose  be  acrid  and  corrosive,  the  discharge  from  the 
cervix  will  have  the  same  irritating  quality :  if  tena- 
cious in  the  larynx,  it  will  be  tenacious  elsewhere ;  if 
green,  yellow,  or  white  in  one  place,  it  will  have  .the 
same  color  elsewhere.  The  idea  of  any  remedy  causing 
specifically  a  mucous  discharge  from  one  surface,  and 
not  from  any  other,  is  absurd  and  unphilosoplycal.  If 
the  physician  will  examine  any  complete  pathogenesis, 
he  will  be  convinced  of  the  truth  of  this  assertion. 
Medicines  have  a  specific  affinity  for  tissues,  not  organs. 
This  is  a  great  truth,  and  one  of  immense  importance 
in  practice,  and  a  valuable  guide  to  our  study  of  the 
science  of  Therapeutics. 

Vaginal  or  Epithelial  LeiicorrJicea. — Owing  to  the 
total  absence  of  a  microscopical  examination  of  the 
leucorrhreal  discharges,  occurring  during  a  proving  of 
our  medicines,  we  cannot  designate  the  remedies  indi- 
cated for  a  strictly  epithelial  discharge ;  nor  can  we 
designate  with  any  more  certainty  the  proper  remedies 
for  a  purulent  leucorrhoea,  although  Jahr  indicates  coo 
minx,  mercurius,  sabina,  china,  sepia,  copaiva,  and 
nitric  acid.  I  do  not  suppose  cocculus  or  china  capa- 
ble of  causing  a  purulent  discharge  from  any  tissue.  It 
is  not  in  the  nature  of  the  medicine  ;  and  I  suspect  if 
the  original  provings  were  examined,  they  would  be 
found  faulty  in  that  respect.  It  is  probable  that  cluna, 
by  its  Honio30pathicity  to  extreme  debility,  will  cure 
purulent  discharges,  for  it  is  now  known  that  anaemia 
will  cause  a  mucous  discharge  to  become  purulent,  and 
a  removal  of  the  debility  will  cause  the  pus  to  disap- 
pear. Cocculus  acts  principally  upon  the  nervous  cen- 
ters, and  it  is  difficult  to  imagine  how  it  can  cure  a  pur- 
ulent discharge. 


TREATMENT    OF   ABORTION.  195 

For  epithelial  leucorrhcea  I  would  theoretically  desig- 
nate— dulcamara,  borax,  bovista,  calcarea,  pulsatilla, 
sulphur,  kail  hyd.,  mere,  iod.,  senecio,  cannabis,  copaiva, 
cubebs,  euphrasia  and  sticta. 

For  the  different  varieties  of  vaginal  leucorrhcea,  I 
would  refer  the  reader  to  Jahr,*  who  gives  minutely  the 
syniptomology  of  each  remedy  likely  to  be  useful  in 
leucorrhoea  generally. 

When  it  arises  from  simple,  acute  catarrhal  vaginitis, 
dulcamira,  pulsatilla,  kali  hyd.,  sticta,  senecio  gradlis 
or  mere.  iod.  will  generally  remove  it. 

If  from  aplithom  inflammation,  borax,  caulophyllum, 
sulphw*  and  muriatic  add  will  be  found  most  useful. 
On  a  previous  page  this  form  of  vaginitis  and  its  pecu- 
liar discharge  has  been  mentioned,  also  the  distressing 
pruritus  to  which  it  sometimes  gives  rise,  and  that  it  is 
apt  to  occur  during  pregnancy,  and  be  a  cause  of 
abortion.  The  two  remedies  having  greatest  control  on 
this  variety  of  the  disease  happen  to  be  very  different 
in  constitution.  One  is  a  vegetable,  the  other  a  mine- 
ral substance,  yet  both  exercise  a  similar  effect  upon  the 
organs  of  generation,  as  mentioned  in  the  "  Medicinal 
Causes  of  Abortion."  Both  cause  labor-like  pains, 
and  are  capable,  under  certain  circumstances,  of  causing 
abortion  and  premature  labor.  Both  are  Homoeopathic 
to,  and  curative  in,  aphthae  of  any  mucous  surface.  It 
follows  that  no  remedies  are  likely  to  be  so  useful  in 
threatened  abortion  from  aphthae  and  pruritis,  as  borax 
and  caulophyllum. 

Sulphur,  and  even  sulphuric  acid,  according  to  Hart- 
man,f  are  both  useful  in  aphthae,  but  more  against  the 
constitutional  diathesis,  than  the  immediate  attack  and 
its  consequences. 

*  Diseases  of  Women.  f  Diseases  of  the  Children. 


196  HALE    ON   ABORTION. 

Muriatic  acid,  says  Teste,  is  the  specific  remedy  for 
that  form  of  aphthae,  termed  by  the  French  writers 
muguet,  and  which  may  sometimes  attack  the  vagina, 
especially  in  very  low,  atonic  states  of  the  system. 

The  local  application  of  borax  has  been  mentioned 
under  "Pruritus."  Caulophyllum  may  be  used  as  an 
injection — the  tincture  in  water.  Sulphurous  acid  is 
promptly  curative  in  the  form  of  enema,  when  there 
exists  in  the  vaginal  discharge  the  fungi  peculiar  to 
some  aphthous  diseases.* 

If  the  whole  vaginal  surface  has  become  involved, 
and  by  means  of  the  speculum  we  discern  that  the 
epithelium  has  nearly  or  wholly  disappeared,  leaving 
the  villi  exposed,  the  villous  coat  abraded  and  bathed 
in  pus,  or  if  we  have  to  judge  of  the  leucorrhoea  wholly 
from  the  discharge,  and  we  find  it  composed  of  pus, 
mixed  with  blood  globules,  we  may  assume  the  con- 
dition present  as  the  one  above  described. 

In  such  cases,  the  appropriate  remedies  are  nitric 
acid,  sabina,  sepia,  calcarea,  copaiva,  terebinth,  trillium, 
mercurius,  arsenicum,  etc. 

It  is  utterly  impossible  for  us,  in  the  present  con- 
dition of  our  Materia  Medica,  to  construct  a  reliable 
repertory.  Jahr  mentions  many  remedies  for  "  bloody" 
leucorrhoaa,  many  of  which  are  also  mentioned  under 
the  head  of  "flesh-colored"  and  "reddish  discharges." 
But  how  are  we  to  decide  whether  the  blood-globules 
come  from  the  abraded  cervix  or  vagina,  or  the  interior 
of  the  uterus ;  whether  it  was  really  a  bloody  leucor- 
rho3a,  or  a  simple  mucous  leucorrhoea,  mixed  with  the 
blood  of  a  uterine  haemorrhage?  The  appropriate 
local  treatment  of  this  form  of  vaginal  leucorrhoea  with 
abrasion,  consists  of  injections  of  calendula,  hamamelis, 

*  West  on  Diseases  of  Children. 


TREATMENT   OF   ABORTION.  197 

triUium,  borax,  sanguinaria,  podophyllum  /  or  nitric  add, 
per-manganate  of  potash,  bichromate  of  potash,  OY  nitrate 
of  silver.  Those  first  mentioned  being  mildest,  may  be 
tried  first.  In  many  cases  they  prove  effectual.  The 
proportion  best  adapted  to  the  purpose  is  a  watery 
infusion,*  but  the  mother  tincture  can  be  used  in  the. 
same  proportion.  The  latter,  unless  largely  dil- 
uted, cannot  be  used  with  safety  during  pregnancy. 
They  are  not  as  efficient  when  used  weak,  unless  the 
case  be  a  recent  one.  The  nitric  add  enema  may  be 
prepared  ten  or  twenty  drops  to  the  pint ;  the  per-man- 
ganate of  potash,  ten  grains  to  the  pint ;  the  bichromate 
one  or  two  grains  to  the  pint,  of  water ;  the  argentum 
nitratis,  in  the  same  proportion.  In  non-pregnant 
women,  and  long  standing  cases,  stronger  proportions 
can  be  used. 

Gonorrhoea. — If  this  disorder  has  been  contracted 
previous  to  the  pregnancy,  and  its  results — namely,  ulcer- 
ation,  induration,  and  endo-metritis,  are  disposed  to  act 
as  exciting  causes  of  abortion,  the  treatment  to  be 
adopted  should  be  the  same  as  laid  down  for  those 
affections. 

If,  however,  the  gonorrhceal  infection  occurs  during 
pregnancy,  an  abortion  may  be  caused  by  the  congestion, 
irritation,  and  sympathetic  fever  which  accompanies 
the  outset  of  the  disease.  In  such  cases,  the  woman 
should  be  ordered  to  keep  as  much  as  possible  the 
recumbent  posture,  use  cooling  and  mucilaginous  bever- 
ages, such  as  flax-seed,  marsh  mallows,  or  ulrnus  fulva, 
and  one  of  the  folio  wing  medicines  be  prescribed;  aconite, 
gelseminum,  or  veratrum  viride,  if  the  fever  assumes  a 
high  grade,  with  local  congestion ;  cannabis,  cantharis, 
or  senecio  aw*eus,  if  the  febrile  irritation  is  accompanied 

*  One  drachm  of  the  crude  material  to  one  pint  of  water. 


198  HALE   ON   ABORTION. 

with  much  local  pain  and  irritation ;  sabina,  terebinth, 
and  pulsat'tlla,  if  the  irritation  seems  likely  to  bring  on 
uterine  pain  and  flooding.  If  this  first  stage  passes 
over,  and  the  second,  or  that  mentioned  on  a  previous 
page — namely,  an  inflamed  and  abraded  surface  or  patch 
.  on  the  os  uteri — obtains,  the  same  treatment  as  that 
advised  for  "  granular  ulcer"  should  be  adopted. 


SECTION    V. 

ULCER ATION    OF   THE    OS    AND    CERVIX    UTERI. 

The  therapeutics  of  ulceration  of  the  os  and  cervix 
uteri  cannot  be  considered  at  all  settled.  Those  reme- 
dial agents  which  are  appropriate  in  this  disease,  are 
those  which  are  Homoeopathic  to  the  pathological  con- 
dition, as  well  as  to  the  symptoms  present.  Those 
who  still  assert  that  this  disease  can  be  diagnosed  and 
treated  from  the  symptoms  alone,  should  ponder 
well  over  the  statement  of  Professor  Simpson,  a  state- 
ment concurred  in  by  all  the  best  and  most  practical 
observers  of  both  schools  of  medicine — namely :  "  There 
can  be  no  doubt  of  the  fact,  that  there  seems  to  be  no 
organ  in  which  there  is  a  less  strict  relation  observable 
between  the  intensity  and  character  of  the  existing 
pathological  disease,  and  the  intensity  and  character  of 
the  accompanying  symptoms,  or  between  the  exact 
nature  of  the  structural  lesions  that  are  present,  and 
the  exact  combination  and  succession  of  functional 
derangements  to  which  they  give  rise."  Dr.  Madden* 

*  Uterine  Diseases,  p.  19. 


TREATMENT    OF   ABORTION.  199 

says :  "  In  this  disease  I  have  met  with  the  greatest 
possible  variety  in  the  symptoms  complained  of,  when 
a  physical  examination  revealed  the  greatest  possible 
correspondence  between  the  pathological  conditions  of 
the  various  cases.  I  have  found  enlargement  and  ulcer- 
ation  of  the  cervix  uteri  in  a  case  examined  for  another 
purpose,  and  when  there  was  no  detectable  aberration 
from  robust  health.  I  have  found  the  slightest  form  of 
cervico-metritis  where  the  constitutional  disturbance  was 
very  grave,  and  the  symptoms  had  continued  a  long 
time ;  and  lastly,  I  have  known  the  symptoms  to  con- 
nect themselves  so  completely  with  some  distant  organ, 
as  the  head,  the  stomach,  the  heart,  the  mammae,  or 
the  extremities,  that  indirect  causes  alone  led  me  to 
suspect  the  uterine  complication." 

How  is  the  mere  symptomotologist  to  select  the  appro- 
priate remedy  for  a  case  of  ulcerated  as,  if  he  ignores 
all  pathological  conditions  ?  He  has-  nothing  to  do 
with  conditions,  therefore  he  must  not  avail  himself  of 
the  general  state  of  the  patient — i.  e.,  whether  she  is 
disposed  to  liberations ;  nor  can  he  be  guided  by  the 
cliscJiarges,  for  a  discharge  is  a  pathological  symptom. 
Even  if  we  allow  him  to  be  guided  by  the  appearance 
of  the  discharge,  per  vaginam,  he  would  be  as  likely  to 
be  misled,  unless  the  microscope  revealed  to  him  its 
real  character. 

It  is  because  our  Materia  Medica  is  so  incomplete, 
especially  in  objective  symptoms  (structural  lesions), 
that  our  therapeutics  of  ulceration  of  the  uterus  are  so 
uncertain  and  unsettled.  Says  Dr.  Madden:  "On 
going  over  the  whole  of  the  remedies  which  have  been 
proved  by  Hahneinann  and  his  followers,  *  *  *  I  can 
only  find  four  purely  pathological  symptoms  which 


200  HALE    ON    ABORTION. 

indicate  organic  changes  in  the  uterus,  and  these  are  as 
follows : 

(1)  "  Irregularity  of  the  os  uteri" — natmm  muriati- 
cum. 

(2)  "Metritis" — secede  cornutum. 

(3)  "  Softness  of  uterus" — opium. 

(4)  "  Swelling  of  cervix" — canthari*. 

It  is  needless  to  add  that  the  symptoms  noted  under 
natrum  muriaticurn,  and  that  under  opium,  cannot  be 
trustworthy.  Secale,  in  poisonous  doses,  causes  a  severe 
form  of  rnetritis,  and  the  same  may  be  predicated  of 
canthwis.  So  that,  of  all  the  medicines  in  our  Materia 
Medica,  but  two  have  a  recorded  and  reliable  objective 
symptom  relating  to  the  uterus.* 

The  condition  of  the  knowledge  of  uterine  path- 
ology, at  the  time  Hahnemann  and  his  immediate  suc- 
cessors made  their  provings,  is  a  valid  reason  for  the 
absence  of  such  symptoms;  but  the  provers  of  the 
present  day  cannot  have  any  such  excuse  for  not  pre- 
senting us  with  pathological  symptoms,  if  not  on 
women,  certainly  upon  female  animals.  Imagine  a 
proving  of  sepia,  pulsatitta,  sabina,  sulphur,  phytolacca, 
kali  bichromat.,  etc.,  conducted  in  such  a  manner  as  to 
elicit  subjective  and  objective  symptoms.  Then,  in- 
deed, could  we  prescribe  with  some  degree  of  confi- 
dence for  the  disease  under  consideration. 

For  particular  information  concerning  the  Homoeo- 
pathic treatment  of  ulceration  of  the  os  and  cervix,  I 
would  refer  the  physician  to  "  Madden  on  Uterine  Dis- 
eases," "  Jahr  on  Diseases  of  Women  "  "  Gollmann  on 
* 

Diseases  of  Urinary  and  Sexual  Organs,"  and  the 
papers  which  have  appeared  in  our  various  journals, 

*  Aquaphobin  causes  "inflammation    of    the  uterus   in  cows."       See 
"  Proving  of  Aquaphvbin"— Phila.  Jour,  of  Horn.,  vol.  iii.,  p.  262. 


TREATMENT    OF   ABOETION.  201 

also  Dr.  Ludlain's  forthcoming  work  on  Diseases  of 
Women. 

Madden  found  the  most  useful  remedies  in  uterine 
diseases  generally,  to  be  pulsatilla,  sepia,  sulphur,  nux 
vomica,  and  platina.  He  also  used  local  applications 
of  nitrate  of  silver,  per-nitrate  of  mercw^y,  and  potassa 
fusa,  and  claims  that  these  drugs  have  a  specific  action 
on  uterine  disorders,  acting  Honiceopathically,  whether 
as  constitutional  or  local  remedies. 

Jahr  recommends  (1)  nitric  acid  and  thuja ;  (2) 
arsenicum,  belladonna,  china,  cicuta,  cocculwi,  inercurius, 
pulsatilla,  sepia,  silicea,  and  sulphur.  Of  these,  nitric 
acid,  arsenicum,  mercurius,  sepia,  silicea,  and  sulphur, 
are  most  worthy  to  be  relied  upon.  It  is  doubtful  if 
the  others  are  Homoeopathic  to  ulceration  at  all.  Jahr 
mentions  a  few  others  which  are  probably  appropriate, 
namely,  calcarea,  aurum,  graphites,  petroleum,  ruta, 
sabina,  secale,  Jiepar  sulph.,  and  lacJiesis.  Dr.  Marcy* 
recommends  against  "  simple  inflammation  of  the  mu- 
cous membranes  lining  the  cervical  canal  and  the  cervix 
uteri,"  sepia,  secale^  sabina,  pulsatilla,  cocculus,  apis 
mel.,  calc.  carb.  •  also,  mezereum,  conium,  nitric  acid, 
petroleum,  bovista,  boi*ax,  platina,  kali  carb.,  f err.  iod., 
and  sulphur. 

For  "suspected  ulcerations,"  he  has  found  most  use- 
ful, secale,  apis,  and  thuja;  also  the  above  mentioned 
remedies. 

Leadam  seems  to  teach  that  "  simple  induration"  of 
the  os  uteri  and  cervix  uteri,  precedes  ulceration,  and 
is  the  result  of  chronic  inflammation.  The  remedies 
which  he  advises  for  this  condition  are,  belladonna, 
platina,  calendula,  sepia,  conium,  arsenicum,  iodium, 
aurum,  etc. 

*  N.  A.  Jour,  of  Horn.,  vol.  v.,  p.  80. 


202  HALE   ON   ABORTION. 

The  constitutional  remedies  which  observation,  ex- 
perience, and  information  gleaned  from  all  sources, 
indicate  as  most  appropriate  for  the  inflammation  and 
engorgement,  which  precedes  ulceration,  are — sabina, 
secale,  cimicifuga,  caulophyllin,  belladonna,  pulsatilla, 
apis  met.,  aqyaphobin,  podophyllum,  murex,  mitchella, 
cantharis,  and  platinum  chlor.,  when  the  condition  is 
acute  or  recent.  In  chronic  cases,  sepia,  sulphur,  helo- 
nias,  aletris,  platina,  lachesis,  conium,  thuja,  and  mere, 
iod.,  are  more  often  indicated. 

Any  remedy  which  has  been  found  useful,  or  is 
indicated  by  its  pathogenesis,  in  inflammation  and 
induration  of  other  portions  of  the  body  having  a  like 
tissue  with  the  cervix  uteri,  will  be  likely  to  prove 
serviceable  in  this  affection. 

In  the  treatment  of  inflammatory  congestion,  and 
induration  of  the  os  and  cervix,  the  use  of  topical 
applications  should  not  be  neglected.  The  Homoeo- 
pathic school  are  divided  in  opinion,  as  to  the  pro- 
priety of  such  applications,  the  conservative,  or  Hahne- 
mannian  party,  claiming  that  the  internal  administration 
of  the  proper  remedy  is  alone  sufficient  to  bring  about 
a  cure — the  progressive  party  believing  it  necessary  and 
proper  to  apply  the  same  medicine  which  is  prescribed 
internally,  to  the  diseased  portion  or  tissue,  or  medicines 
that  by  their  local  action  are  Homceopathic  to  the 
lesion  present,  when  topically  applied. 

I  incline  to  the  latter  belief,  because  my  observation 
and  experience  has  shown  me  that  our  success  is  greater 
when  remedies  are  applied  to  the  diseased  structures, 
topically,  as  well  as  when  reaching  them  through  the 
medium  of  the  general  circulation. 

The  treatment  laid  down  in  these  pages  is  conse- 
quently based  on  this  belief.  At  the  same  time,  I  am 


TREATMENT    OF   ABORTION.  203 

willing  to  allow  the  largest  liberty  of  action  to  all  the 
members  of  the  Homoeopathic  school. 

The  topical  treatment  of  the  inflammatory  condition 
which  precedes  ulceration,  should  consist  of  the  appli- 
cation by  enema  or  lint,  of  the  following  medicines  (or 
others  which  seem  indicated). 

(1)  For  simple  inflammation — aconite,  gelseminum, 
a/i^nica,  calendula,  baptisia,  cimicifuga,  and  secale. 

(2)  Inflammation  with  induration — the  above,  and 
also  urtica  urens,  belladonna,  kali  Tiyd.,   kali  brom., 
conium,  and  clematis. 

These  remedies  should  be  prepared  in  proportion  of 
ten  or  twenty  drops  of  the  mother  tincture  to  four 
ounces  of  water,  and  the  whole  quantity  used  at  once ; 
or  if  the  remedy  is  applied  by  means  of  lint,  it  should 
be  saturated  with  a  preparation  made  in  proportion  of 
ten  or  twenty  drops  to  one  half  ounce  of  water.  The 
water  may  be  cool  or  warm,  as  the  physician  judges 
best.  It  should  be  remembered  that  cold  applications 
to  the  os  uteri,  during  pregnancy,  are  sometimes  capable 
of  exciting  reflex  irritation. 

The  syringe  used  for  such  purposes  may  be  the  com- 
mon vaginal  syringe,  made  of  hard  rubber,  and  holding 
two  ounces ;  or  one  of  the  various  instruments  which  are 
sold.  I  prefer  the  Essex  syringe,  with  the  air  chamber. 
The  tube*  should  be  inserted  so  that  the  bulb  is  nearly 
in  contact  with  the  os,  and  the  fluid  should  be  thrown  in 
a  slow,  continuous  stream.  If  thrown  with  too  much 
force,  uterine  contractions  (in  case  of  pregnancy)  may 
be  caused.  If  lint  is  used,  it  should  be  applied  through 
a  speculum ;  it  should  be  pressed  gently  against  the  os, 

*  A  large  vaginal  tube,  with  a  large  bulb,  perforated  with  holes  one- 
sixteenth  or  one -twelfth  of  an  inch  in  diameter — should  be  obtained  with 
the  syringe.  It  is  made  expressly  for  this  use,  and  can  be  purchased  from 
Mr.  Halsey,  the  publisher  of  this  work. 


204  HALE    ON    ABORTION. 

and  kept  in  situ  with  a  sound,  or  anything  which  will 
answer  that  purpose,  while  the  speculum  is  withdrawn. 
The  best  time  to  apply  medicated  lint  is  at  night ;  it  may 
be  removed  in  the  morning ;  this  the  patient  can  gener- 
ally do ;  indeed  she  can  often  apply  it  herself,  if  the 
uterus  is  low  in  the  pelvis.  These  general  directions 
are  applicable  in  case  of  any  disease  of  os  and  cervix, 
when  remedies  are  to  be  used  topically. 

We  will  now  consider  briefly  the  treatment  of  the 
varieties  of  ulceration. 

Simple  Granulating  Ulcer. 

The  remedies  most  generally  useful  are  arsenicum, 
platinum  chlor.,  phytolacca,  stillingia,  sabina,  kali  hy- 
driodatus,  mercurius  iodatus,  secale,  sepia,  nitric  acid, 
podophyllum,  hepar  sulph.,  calendula,  kreosotiwi,  nym- 
phcea  odorata,  cornus  circinata,  kali  chlor.,  hydrastis 
canadensis,  argentum  nitricum. 

The  same  remedies  should  be  applied  topically  in  such 
proportions  as  have  been  heretofore  indicated  in  this 
work,  leaving  the  special  preparations  (as  nitrate  of  sil- 
ver, etc.)  to  the  judgment  of  the  practitioner.  My  ex- 
perience with  arg.  nit.,  in  simple  erosions,  leads  me  to 
prefer  the  enema  to  be  very  weak — 2  grs.  to  8  §  —  and 
frequently  used. 

Varicose  Ulcwation. 

The  practical  experience  of  physicians,  and  the  path- 
ogenesis  of  medicines,  seem  to  indicate  that  this  variety 
is  best  treated  by  use  of 

Collinsonia,  hamamelis,  lycopodium,  pukatilla,  graph- 
ites, lachesw,  thuja,  sepia,  trillium,  sulphw,  nux  vomica, 
and  arnica,  prescribed  for  internal  and  topical  use. 


TREATMENT    OF   ABOETION.  205 

The  hamamelis  is  the  most  generally  useful  remedy 
in  this  disease.  But  to  be  efficacious  it  should  be  used 
in  material  doses  (10  or  15  drops  of  the  tincture  inter- 
nally) and  the  watery  infusion*  used  as  an  enema. 
Thuja,  trillium,  nux  vomica,  and  arnica,  may  be  also 
used  in  infusion,  but  of  less  strength.^  Lycopodium, 
lachesis,  graphites,  and  sulphur,  are  efficacious  internally, 
in  the  30th  or  200th  potency. 

Fissured  Ulcer. 

In  the  Repertories  we  find  recommended  for  rhagades 
generally,  alumina,  cole,  carb.,  hepar  sulph.,  lycopodium, 
'inercurius,  petroleum,  rhus  tox.,  and  sulphur. 

It  is  probable  these  may  be  equally  useful  in  fissured 
ulcer  of  the  os  uteri.  But  in  my  estimation  the  chief 
remedy  is  nitric  acid.  Those  who  are  acquainted  with 
the  specific  curative  power  of  this  remedy  in  fissures  of 
the  anus,  fissures  of  the  tongue  and  lips,  can  readily 
believe  this  assertion.  It  has  cured  this  lesion,  in  the 
low  and  high  dilutions,  with  or  without  its  local  appli- 
cation, yet  I  am  inclined  to  recommend  that,  in  old  and 
severe  cases,  it  be  applied  locally.  This  may  be  accom- 
plished by  the  use  of  an  enema  in  the  proportion  of  ten 
drops  of  the  dilute  acid  to  four  ounces  of  water ;  or  the 
dilute  acid  itself,  applied  with  a  soft  brush.  The  ulcer 
should  first  be  wiped  dry  to  the  bottom  of  the  fissure, 
with  a  piece  of  lint  attached  to  a  probe,  and  the  brush 
pushed  into  the  depth  of  the  ulcer.  The  remedies  first 
named,  also  nitrate  of  silver^  and  glycerole  of  aloes, 
may  be  applied  in  a  similar  manner.  The  glycerole  of 
aloes  is  already  widely  and  favorably  known  as  almost 

*  Hamamelis  (the  bark)  §  i — warm  water  1  qt. — infuse  3  hours, 
f  3  i  of  the  powder,  leaves,  or  flowers,  to  1  qt.  water. 
$  Arg.  nit.  (crystals)  gr.  x. — aqua  dest.  1 1 . 


206  HALE  OX   ABORTION. 

a  specific  for  rhagades  in  the  skin.  In  the  few  cases  in 
which  I  have  used  it  in  similar  states  of  the  mucous 
membranes,  it  has  proved  equally  efficacious.  The  bi- 
chromate of  potash  has  been  found  very  useful  in  certain 
conditions  similar  to  fissured  ulceration.  Dr.  Dudgeon 
used  it  internally  and  topically. 

Follicular  Ulceration. 

The  remedies  are  (1)  mere.  iod.  and  bin-iod.,  kali 
iod.,  kali  brom.,  phytolacca,  stillingia,  baptisia,  sabina, 
sulphur,  nitric  acid,  silicea,  sanguinaria,  thuja. 

(2)  Argentum  nit.,  per-manganate  of  potash,  chlorate 
of  potash,  and  potassa  fusa. 

The  first  class  should  be  used  internally  and  topical- 
ly ;  the  second,  in  most  cases  topically  alone,  although 
in  some  cases  their  internal  administration  may  be 
appropriate. 

If  the  follicular  ulcer  is  seen  in  its  incipient  stage, 
one  or  two  applications  of  the  crude  nitrate  of  silver  to 
the  surface  will  suffice  to  heal  it :  at  a  later  period, 
when  an  excavated  ulcer  is  present,  the  strong  solution 
of  that  caustic,  or  the  per-manganate  of  potash  (of  the 
same  strength)  should  be  applied  with  a  pointed  brush, 
pushed  to  the  bottom  of  the  excavation.  In  some  cases, 
according  to  Madden  and  Tilt,  the  potassa  cum  calce, 
applied  in  the  form  of  the  crude  stick,  causes  rapid  fill- 
ing up  of  the  ulcer. 

Phagedamic  Ulcer. 

This  is  the  "corroding  ulcer"  of  Leadam,  who  is 
sanguine  in  the  recommendation  of  arsenicum  as  the 
principal  remedy.  That  author  also  advises  sulphur, 
secale,  lachesis,  iodiurn,  carb.  veg.,  and  pulsatilla. 


TREATMENT   OF   ABORTION.  207 

With  the  single  exception,  however,  of  lachesis,  it  is 
extremely  doubtful  if  any  of  the  last-named  are  Homoa- 
opathic  to  phagedsena,  in  any  form :  not  even  secale, 
which  is  only  useful  in  dry  gangrene,  if  in  gangrene 
at  all. 

The  remedies  appropriate  in  this  form  of  disease  — 
true  phagedsenic  ulceration  (not  cancerous),  are,  nitric 
acid,  muriatic  acid,  per-manganate  of  potash,  Jiydrastis 
canad.,  phytolacca,  iodide  of  arsenic,  arseniate  of  iron, 
tartrate  of  iron  and  potassa  /  nymphcea  odorata,  mere, 
bin-iod.,  kali  hyd.  and  stillingia. 

These  remedies  should  be  used  thoroughly  and  per- 
severingly,  internally  and  topically,  as  before  described. 
The  tartrate  of  iron  and  potassa  was  said  by  Ricord 
to  be  the  "  sworn  enemy  of  phagedsena.*'  One  patient, 
with  an  ill-looking  ulcer  of  this  character  upon  the  os, 
I  cured  with  the  first  trituration  of  this  remedy  alone. 
There  was  present  considerable  anaemia  and  debility. 
Dr.  P.  H.  Hale,  of  Michigan,  uses  the  nymplicea  odorata 
(white  pond  lily)  with  much  success  in  this  form  of 
ulceration. 

The  remedies,  however,  which  have  been  most  useful 
in  my  hands,  for  phagedsena,  whether  syphilitic  or  not, 
have  been  the  bin-iodide  of  mercury,  in  alternation  with 
Jcali  liyd.  It  is  a  curious  fact,  but  one  observed  by 
others  besides  myself,  that  some  remedies  will  cure 
promptly  when  given  in  alternation,  after  they  have 
failed  singly.  This  is  the  case  with  the  above  remedies. 
Neither  the  bin-iodide  nor  iodide  of  potash  were  capable 
of  curing  alone,  but  when  alternated,  they  removed  the 
diseased  condition  rapidly.  I  usually  prescribe  the 
former  in  the  third  decimal  trituration :  the  latter  in 
solution,  after  the  formula  given  below*  (about  the 

*  5  Kali  hydriodatus  3  i. 

Aqua  dest.  or  syrup,  simp.  §  viii.    One  teaspoonful  three  times  daily. 


208  HALE   ON   ABOKTION. 

second  dilution) :  each  three  times  daily :  the  former 
before  meals,  the  latter  about  two  hours  after.  I  know 
of  no  treatment  so  uniformly  successful,  and  strongly 
advise  its  adoption.  Dr.  W.  T.  Helmuth  informs  me 
that  he  uses  successfully,  in  this  condition,  the  same 
medicines  in  nearly  the  same  manner. 

Next  to  this,  I  prefer  the  use  of  per-manganate  of 
potash.  Manganese  is  a  blood-restorer,  like  iron,  and 
the  large  amount  of  eklorifa  contained  in  the  prepara- 
tion, makes  it  a  powerful  remedy  over  diseased  states 
which  lead  to  phagedsena.  Besides,  it  is  a  powerful  but 
safe  caustic,  acting  as  a  local  Homceopathic  remedy. 
The  third  dilution  may  be  administered  internally,  and 
the  strong  solution  (ten  grs.  to  one  ounce  of  water)  ap- 
plied with  a  brush  or  lint. 

Syphilitic  Ulceration. 

The  treatment  of  chancres  on  the  os  uteri,  or  the 
ulceration  which  follows  it,  does  not  materially  differ 
from  that  adopted  for  the  last  named  variety. 

Simple  chancre  of  the  os  will  often  heal  kindly  under 
the  use  of  mercwrim  sol.,  or  mere,  iodatus,  or  nitric 
acid,  together  with  a  wash  of  aqua  calendulw,  dilute 
nitric  acid,  or  the  preparations  previously  mentioned 
for  enemas. 

Indurated  chancre  requires  the  same  mercurial  reme- 
dies, aided  by  kali  hydriodatus,  stillingia,  or  phyto- 
lacca. 

Phagedcenic  ulcerations,  of  a  syphilitic  character, 
require  the  same  treatment  as  phagedaena  arising  from 
non-specific  causes.  In  this  affection  I  have  used  the 
mere,  bin-iod.  and  Icali  hydriodatus  in  alternation,  with 
the  happiest  results. 


TREATMENT    OP   ABORTION.  209 

A.urum,  kali  bichrom.,  platinum  chlor.,  iris  versicolor, 
and  arsenicum,  have  all  been  highly  recommended  in 
syphilitic  ulcers,  but  rny  experience  with  them  has 
been  so  limited,  that  I  am  unable  to  report  favorably 
in  relation  to  their  therapeutic  value. 

Hesumt. 

There  are  many  remedies  not  specially  indicated  in 
ulceration  of  the  os  and  cervix,  which  may  be  useful 
and  indispensable  to  the  cure  of  that  affection. 

It  is  well  known  that  certain  states  of  the  system, 
namely,  anaemia,  psora,  some  miasmatic  or  dyscratic 
poison,  may  retard  and  even  prevent  the  cure  of  local 
or  general  diseases  of  a  different  character.  Thus,  if 
considerable  anaemia  be  present,  we  may  select  the 
remedy  for  the  local  affection  with  ever  so  much  care,  but 
if  we  do  not  take  into  account  the  general  condition,  and 
select  some  remedy  to  meet  it,  we  shall  fail  to  effect  a 
cure.  It  is  very  rarely  the  case  that  any  one  remedy 
will  meet  both  conditions,  namely — the  ulcer  (syphilitic 
or  not)  and  the  anaemia;  we  therefore  are  obliged  to 
alternate  two  remedies,  for  example,  ferrum  and  mer- 
curius:  china  and  phytolacca :  hydrastis  and  kali  hydri- 
odatus. 

Again,  if  a  psoric  taint  exist  in  the  organism,  we 
will  have  to  act  upon  the  advice  of  Hahnemann,  and 
give  an  occasional  dose  of  some  anti-psoric — sulphur, 
calcarea,  etc.  (30th  or  200th),  to  antidote  that  miasm, 
and  the  cure  will  afterwards  progress  rapidly. 

In  miasmatic  districts  we  sometimes  have  to  use 
arsenic,  or  quinine,  before  other  remedies  will  exercise 
a  curative  effect  on  the  disease. 

During  the  prevalence  of  epidemics  of  diphtheria, 
14 


210  HALE   ON   ABORTION. 

ulcers  of  all  kinds  are  apt  to  take  on  a  diphtheritic 
character — ulcers  situated  on  the  os  and  cervix  are  not 
an  exception.  When  this  occurs — and  the  careful  phy- 
sician will  be  on  the  alert  for  such  a  complication — 
the  remedies  recommended  for  diphtheria  will  have  to 
be  resorted  to. 

I  hardly  need  add,  what  every  practical  physician 
should  know,  that  during  the  treatment  of  ulceration, 
the  physiological  functions  of  the  various  organs  should 
be  kept,  as  much  as  possible,  in  a  normal  condition. 
Respiration,  digestion,  and  depuration,  should  go  on 
properly,  or  the  cure  will  be  retarded. 

The  diet  of  the  patient  should  be  varied  to  suit  the 
exigencies  of  each  individual  case,  the  use  of  stimulants 
advised  or  not,  as  the  system  demands.  The  amount 
and  character  of  exercise  should  be  regulated  in  the 
same  manner. 

It  has  always  appeared  to  me  that  the  postural  treat- 
ment of  ulcers  of  the  cervix,  has  not  received  the  at- 
tention which  it  demands.  If  we  are  treating  an  ulcer 
on  the  foot  or  leg,  we  know  it  will  heal  in  much  less 
time  if  the  limb  is  placed  horizontally,  so  that  the 
column  of  blood  does  not  press  upon  the  irritable  tissues 
in  or  near  the  ulcer.  Should  not  the  same  hold  true, 
to  a  certain  degree,  in  the  case  of  ulcers  situated  upon 
the  most  depending  portion  of  the  uterus  ?  We  are 
aware  that  some  writers  do  advise  the  patient  to  assume 
and  remain  in  the  recumbent  position  while  under 
treatment,  but  not  for  the  reason  above  alluded  to.  I 
am  satisfied  that  if  this  suggestion  be  borne  in  mind 
by  the  physician,  and  acted  upon  in  certain  cases,  his 
success  will  be  much  greater,  especially  if  he  is  treating 
a  case  of  ulceration  occurring  during  pregnancy,  when, 


TREATMENT    OF    ABORTION.  211 

more  than  at  any  other  period,  the  uterus  is  loaded 
with  blood. 

There  is  another  reason  why  the  recumbent  posture 
should  be  advised.  It  is  well  known  that  ulcers  and 
abrasions  of  the  os,  are  kept  open,  and  irritated  by  the 
constant  contact  with,  and  rubbing  against  the  pos- 
terior wall  of  the  vagina,  upon  which  the  cervix  rests 
in  most  cases  in  the  early  months  of  pregnancy.  The 
most  carefully  selected  remedies  will  not  effect  a  cure, 
when  this  irritation  is  kept  up.  In  non-pregnant 
women  we  can  insert  a  pessary,  and  lift  the  uterus  up 
from  the  vaginal  wall,  but  during  pregnancy  the  use  of 
pessaries  are  generally  objectionable,  and  our  best 
means  of  aiding  the  medicinal  treatment  is  to  allow 
the  patient  to  stand  or  sit  but  a  small  portion  of  the 
time,  or  until  the  ulcer  shall  be  covered  by  a  healthy 
mucous  membrane. 

It  is  in  these  cases,  especially  in  women  of  large 
size,  that  the  abdominal  bandage  is  found  a  useful 
mechanical  auxiliary.  The  best  bandage  is  made  of 
elastic  silk  and  rubber,  woven  whole,  or  laced  at  the 
back  or  sides. 

On  account  of  the  irritation  and  congestion  conse- 
quent upon  the  act  of  coition,  it  is  best  to  prohibit 
sexual  intercourse  almost  entirely  during  the  treatment 
of  uterine  ulceration  in  pregnant  women. 

Ovarian  Diseases. 

When  we  have  to  deal  with  a  simple  ovarian 
irritation,  from  perverted  physiological  influences,  the 
treatment  will  be  nearly  the  same  as  recommended 
for  "  Return  of  Menstrual  Crisis," — namely,  the  avoid- 
ance of  all  sensual  emotions,  coition,  etc.,  and  the 
use  of  remedies  which  have  a  sedative  effect  upon 


212  HALE   ON   ABORTION. 

the  ovaries.  These  are  (1)  cantharis,  cannabis  indica, 
apis  mel.,  platina,  sabina,  podophyllum,  lachesis,  zincum 
valei*ianatum,  all  of  which  should  be  used  in  the  higher 
dilutions  ;  and  (2)  bromide  of  potash,  and  conium,  if  the 
remedies  of  the  first  class  fail  to  relieve.  The  latter 
medicines  must,  however,  be  given  in  doses  of  one  grain, 
or  more,  of  the  TV  trituration,  twice  or  thrice  daily. 

Neuralgia  of  the  ovaries  (if  such  a  disease  exists) 
requires  the  use  of  atropine,  aconite,  apis,  colocynth, 
lachesi*,  and  zincum  valerianatum. 

Congestion  and  inflammation  is  treated  successfully 
with  aconite,  veratrum  viride,  gelseminum,  belladonna, 
mercurius,  apis  'mel.,  lachesis,  and  platinum.  Ovarian 
tumors  and  dropsy  may  be  held  in  check  by  apis, 
lachesis,  lycopodium,  arsenic,  iodine,  kali  brom.,  kali 
chlor.  and  phytolacca.  In  some  cases  the  ovaries  can 
be  punctured,  and  the  escape  of  pus  or  serum  may  allow 
pregnancy  to  go  on  undisturbed.  It  is  quite  doubtful 
if  a  diseased  ovary  could  be  removed  without  resulting 
in  abortion ;  cases  might  occur  where  the  experiment 
would  be  justifiable. 


SECTION    VI. 

UTERINE   DISPLACEMENTS. 

The  treatment  of  displacements  of  the  uterus  during 
pregnancy  in  such  a  manner  as  to  avoid  the  risk  of  an 
abortion,  is  a  matter  of  considerable  difficulty.  Most 
writers  on  Diseases  of  Women  insist  upon  the  employ- 
ment of  medicinal  and  postural  measures  alone,  and 
assert  it  to  be  improper  to  resort  to  mechanical  appli- 
ances in  any  case.  But  the  absolute  banishment  of 


TREATMENT  OF  ABORTION.  213 

mechanical  aids  in  such  cases  is  not  based  on  practical 
experience,  as  will  be  shown  in  the  following  para- 
graphs. 

Prolapsus  Uteri. — A  certain  amount  of  prolapsus  is 
a  common  accompaniment  of  pregnancy  in  the  early 
months ;  but  after  a  time  the  uterus  no  longer  descends, 
the  ovum  acting  as  a  very  efficient  intra-uterine  pessary. 
If  this  does  not  occur  at  a  proper  time,  all  that  is  re- 
quired is  a  return  of  the  uterus  to  its  normal  position 
by  gentle  pressure,  and  the  continuance  in  the  recum- 
bent position  for  a  time,  together  with  the  administra- 
tion of  the  following  remedies : 

Belladonna,  if  the  pelvic  organs  are  abnormally  con- 
gested, with  throbbing  at  the  cervix  and  heat  of  the 
parts,  observable  by  the  touch. 

Nux  vomica,  when  the  vaginal  and  other  muscles 
upon  which  the  uterus  depends  for  its  support,  are  in  a 
relaxed,  atonic  condition,  and  there  is  constipation  from 
torpor  of  the  bowels.  This  remedy  may  be  used  also 
as  a  vaginal  enema. 

Podophyllum,  collinsonia  and  msculus,  are  applicable 
if  there  is  general  fullness  of  the  veins  of  the  pelvis — 
especially  the  hsemorrhoidal  veins — constipation  or 
diarrhoea,  and  uterine  tenderness. 

Gaulophyllin,  macrotin  and  secale  if  the  pain  and 
pressing-down  in  the  uterus  are  the  most  prominent 
symptoms. 

Pessaries  are  not  generally  well  borne,  owing  to  their 
tendency  to  excite  reflex  irritation.  In  two  cases,  how- 
ever, of  prolapsus  from  great  relaxation,  I  used  the 
™<7-pessary  for  nearly  two  weeks,  without  any  other 
than  beneficial  effects.  These  patients  were  quite  de- 
bilitated, but  this  was  overcome  by  the  use  of  citrate  of 
iron  and  strychnia  and  helonias,  with  a  generous  diet. 


214  HALE    ON   ABORTION. 

If  adhesions  have  taken  place,  abortion  is  inevitable, 
and  may  as  well  be  hastened,  and  the  patient  saved 
the  risk  of  a  miscarriage  at  a  later  period. 

Ant'  /•,  ,-slnn. — In  the  first  month  or  two  of  pregnancy 
a  slight  anteversion  of  the  uterus  is  its  normal  position. 
If  this  is  greater  than  natural,  an  elastic  abdominal 
bandage  should  be  worn,  the  patient  advised  to  lie  a 
good  deal  on  her  back,  and  the  rectum  emptied  daily 
by  an  enema.  The  medicines  most  likely  to  be  of  use 
are  belladonna,  nux  vomica,  cimicifuga,  caulophyllum^ 
podophyttum,  senecio  gracilis,  and  collinsonia.  For  the 
irritation  of  the  bladder  we  may  give  cantharis,  canna- 
bis,  chimaphilla,  senecio  aureus,  sabina,  terebinth;  and 
use  the  catheter  if  necessary. 

Retroversion. — The  treatment  of  «retroversion  of  the 
pregnant  womb  should  be  conducted  with  great  cau- 
tion, unless  we  are  satisfied  that  adhesions  exist,  or  such 
an  amount  of  impaction  is  present  as  to  utterly  pre- 
clude its  replacement,  in  which  case  the  induction  of 
abortion  is  an  absolute  necessity,  unless  nature  does  not 
perform  the  operation  herself,  and  relieve  the  uterus  of 
its  contents.  When  we  have  ascertained  that  a  retro- 
faxion  exists,  every  means  in  our  power  should  be 
adopted  to  prevent  further  displacement.  The  bladder 
should  be  kept  empty,  and  the  bowels  never  suffered 
to  go  more  than  a  day  without  evacuation.  For  this 
latter  purpose,  the  use  of  ?iux  vomica,  podophyllum,  and 
sulphur,  should  be  aided  by  aperient  food  —  coarse 
bread,  fruit,  etc. — and,  if  necessary,  the  use  of  injections. 
If,  however,  introversion  has  occurred,  attempts  to 
restore  it  to  position  should  at  once  be  adopted.  The 
rectum  and  bladder  must  be  emptied  of  their  contents, 
and  the  fundus-uteri  be  elevated  by  gentle,  firm  and 
persistent  pressure  by  the  two  fore-fingers  of  the  right 


TREATMENT    OF   ABOKTION.  215 

hand.  If  this  does  not  succeed,  the  patient  should  be 
placed  on  her  knees  in  bed,  with  her  head  lowered ; 
the  fore-finger  of  one  hand  should  be  introduced  into 
the  vagina,  the  other  into  the  rectum ;  the  os  should 
then  be  drawn  down  with  the  one,  and  the  fundus 
elevated  with  the  other.  In  some  cases  the  finger  is 
unable  to  seize  the  os,  so  as  to  exert  the  necessary  trac- 
tion, in  which  case  the  bent  extremity  of  the  uterine 
sound  may  be  carefully  introduced  a  short  distance  into 
the  os,  and  the  uterus  drawn  downward  thereby. 

M.  Gariel  has  proposed  that  one  of  his  vulcanized 
india-rubber  pessaries  should  be  introduced  into  the 
rectum,  and  that  the  fundus-uteri  should  be  raised  by 
inflating  the  pessary.  I  do  not  know  if  this  plan  has 
been  tried  in  practice,  but  it  would  probably  be  effect- 
ive in  a  case  admitting  of  mechanical  re-adjustment  of 
the  uterus.  If  it  should  cause  abortion,  it  would  only 
hasten  an  inevitable  result.  Tyler  Smith  thinks  it 
might  lacerate  the  soft  parts  unless  great  caution 
was  observed.  The  instrument,  itself  consists  of  a 
dilatable  air  pessary,  terminating  in  a  tube,  and  an 
air  reservoir,  with  small  taps  affixed  to  each.  After 
immersion  in  warm  water,  the  collapsed  pessary  is  in- 
sinuated into  the  rectum,  behind  the  uterus,  by  means 
of  a  probe.  The  air  reservoir  is  then  fitted  to  the  tube 
of  the  pessary,  the  taps  are  opened,  and  by  the  pressure 
of  the  hand  the  air  contained  in  the  reservoir  is  trans- 
ferred to  the  pessary,  so  as  to  lift  the  uterus  out  of  the 
hollow  of  the  sacrum.  This  instrument  is  also  called 
a  colpeurynteur,  and  is  sold  at  all  Pharmacies. 

The  uterine  sound  should  never  be  used  if  the  con- 
tinuance of  pregnancy  is  desired,  or  unless  previous 
abortions  during  gestation,  owing  to  the  inability  of 


216  HALE    ON    ABORTION. 

replacing  the  uterus,  should  remove  all  hope  of  con- 
ducting the  pregnancy  to  a  natural  termination. 

The  " levator perinei"  invented  by  Dr.  Sims,  for  the 
purpose  of  exposing  the  whole  of  the  vaginal  walls  as 
well  as  the  os  uteri,  has  been  used  by  Dr.  Helmuth 
with  success  in  a  case  of  retroversion  during  pregnancy. 
When  the  necessary  traction  was  made,  the  uterus 
quickly  resumed  its  normal  position.  To  use  this  in- 
strument, place  the  patient  as  nearly  as  possible  lying 
upon  her  breast  and  stomach,  her  left  arm  thrown  be- 
hind, and  the  chest  rotated  forward,  bringing  the  sternum 
quite  in  contact  with  the  bed ;  the  feet  drawn  up,  one  ex- 
tremity of  the  instrument  is  to  be  inserted  into  the  vulva, 
and  by  the  other  the  perineum  is  to  be  forcibly  lifted  up, 
allowing  the  atmosphere  to  dilate  the  vagina.  This 
will  give  a  full  view  of  the  entire  vaginal  cavity — 
"  better,"  says  Dr.  Gardner,  "  than  the  ordinary  cone- 
shaped,  or  even  the  many-valved  instruments."  Thus, 
besides  its  use  of  replacing  the  retroverted  womb,  this 
contrivance  may  be  used  instead  of  the  speculum  for  the 
diagnosis,  and  as  an  aid  in  the  treatment  of  the  various 
affections  of  the  os  cervix,  and  vagina. 

For  the  special  medicinal  treatment  of  retroverted 
uterus,  reference  is  made  to  my  treatise  on  that  subject.* 

The  principal  remedies  to  be  used,  after  replacement 
by  mechanical  means,  and  the  enjoin ment  of  a  position 
on  the  face  or  side  when  in  bed  or  in  the  recumbent 
position,  are :  aletris,  helonias,  nux  vomica,  sepia,  iynatia, 
macrotin,  iodide  of  iron,  podopliyllum,  and  secale. 

In  plethoric  women,  or  those  with  a  large  abdomi- 
nal development,  the  use  of  an  elastic  bandage,  worn 
while  the  patient  is  on  her  feet  or  sitting  up,  is  quite 
an  aid  to  our  efforts  in  the  prevention  and  cure  of  this 

*  Therapeutics  of  Retroversion  of  the  Uterus. 


TREATMENT   OF   ABORTION.  217 

malposition.  It  acts  by  lifting  the  weighty  intestines 
off  from  the  uterus,  heavier  than  normal  with  conges- 
tion or  its  natural  contents,  and  it  also  allows  the 
relaxed  muscles  which  support  the  uterus  to  regain 
their  strength  and  tone. 


SECTION    VII. 

REMEDIAL    TREATMENT    OF   ABORTION. 

The  remedial  treatment  of  abortion  may  be  divided 
into 

(1)  The  Mechanical. 

(2)  Th#  Medicinal. 

The  mechanical  consists  of  those  measures  which  are 
to  be  used  when  the  symptoms  of  abortion  have  already 
set  in,  and  may  have  in  view  two  ends — namely,  (a)  the 
arrest  of  the  morbid  process,  and  the  saving  of  the  life 
of  both  mother  and  child,  and  (£)  the  expulsion  of  the 
foetus  and  placenta,  and  the  safety  of  the  mother. 

The  medicinal  consists  in  the  use  of  those  remedial 
agents  which  have  for  their  object  the  same  ends  as 
the  above ;  also  the  palliation  of  the  painful  and  dan- 
gerous symptoms  which  arise  during  the  progress  of 
an  abortion. 

These  cannot  be  treated  of  separately,  as  it  would 
cause  confusion  and  needless  repetition,  we  shall  there- 
fore allude  to  both  in  such  places  as  are  necessary. 

I  here  feel  it  my  duty  to  protest  against  the  stereo- 
typed recommendations  of  Homoeopathic  writers  rela- 


218  HALE    ON    ABORTION. 

tive  to  the  treatment  of  some  of  the  early  symptoms  of 
abortion. 

We  are  told  that  if  the  accident  is  caused  by  a  fall, 
blow,  or  concussion,  we  must  give  arnica,  and  if  from 
a  strain,  we  should  prescribe  rhus  tox.  Why?  Be- 
cause the  former  is  a  good  remedy  for  the  effects  of  a 
foil,  bruise,  or  concussion,  and  the  latter  those  following 
a  "strain"  This  is  as  absurd  as  it  is  unscientific.  Yet 
those  who  have  recommended  this  treatment  are  the 
greatest  sticklers  for  symptomatic  indications. 

The  fact  is,  arnica  is  by  no  means  a  specific  for  the 
first  symptoms  of  abortion,  any  more  than  any  other 
remedy  used  by  us  in  similar  cases.  The  mere  postural 
treatment  which  the  patient  is  subjected  to,  after  a  fall, 
will  sometimes  succeed  in  warding  off  the  abortion, 
while,  without  such,  treatment,  arnica  would  be  of  no 
benefit.  Regarding  rkits  tox.,  it  is  very  doubtful  if  that 
remedy  is  ever  indicated  in  abortion. 

From  whatever  cause  the  symptoms  of  an  impending 
abortion  may  arise,  the  remedy  must  be  selected  strictly 
in  accordance  with  the  symptoms  of  the  patient,  and 
the  pathological  condition  known  or  supposed  to  exist, 
and  in  addition  such  postural  and  dietetic  rules  as  seem 
appropriate. 

In  nearly  all  cases,  as  soon  as  any  of  the  symptoms 
mentioned  above,  as  indicating  an  impending  abortion, 
appear,  we  should  insist  that  the  patient  immediately 
divest  herself  of  all  tight  and  heavy  clothing,  and 
assume  the  recumbent  position  on  a  bed  or  lounge,  and 
lie  as  still  as  possible,  avoiding  all  sudden  movements, 
emotional  excitement,  or  any  effort  whatever  involving 
the  motion  of  the  abdominal  viscera. 

Her  diet  should  be  of  the  simplest  character,  very 
light,  easily  digestible  food,  cool  beverages,  and  the 


TREATMENT  OF  ABORTION.  219 

avoidance  of  all  warm  and  stimulatino;  drink*  or  food. 

O 

It  is  sometimes  well  to  elevate  the  pelvis  somewhat 
higher  than  a  level  position,  by  placing  a  folded  blanket 
under  the  hips,  especially  where  there  is  present  con- 
gestion of  the  uterus,  or  a  previous  concussion ;  also  in 
cases  of  prolapsus.  In  retroversion,  the  position  should 
be  on  the  side  or  face. 

If  the  symptoms  consist  of  the  usual  pains,  un- 
attended by  discharge  of  blood,  one  of  the  following 
remedies  will  be  most  likely  to  remove  the  uterine  irri- 
tation, and  arrest  the  abortion:  caulophyllum,  cimi- 
ci/uga,  aletrisfar.,  chamomilla,  secale,  gelseminum,  nux 
vomica,  belladonna,  tanacetum,  or  any  medicine  cap- 
able of  arousing  the  motor  action  of  the  uterus. 

If,  on  the  contrary,  we  have  haemorrhage,  without 
any  or  but  little  uterine  pain,  we  shall  find  most 
useful — sabina,  cinnamon,  erigeron,  ipecacuanha,  secale, 
sulphuric  acid,  and  arnica. 

If  both  haemorrhage  and  pain  are  present,  the  remedy 
which  will  cover  the  whole  group  of  symptoms  must 
be  selected,  or  failing  in  this,  two  remedies  may  be 
alternated  at  such  intervals  as  shall  seem  proper. 

I  cannot  advise  the  use  of  applications  of  cold  or 
warm  water  in  such  cases.  The  danger  of  reflex  action 
from  them  more  than  outweighs  any  benefit  which  may 
accrue. 

[There  is  one  remedy  much  relied  upon  by  the  Allo- 
pathic school,  in  the  treatment  of  threatened  abortion, 
which  is  certainly  very  successful,  if  a  large  amount  of 
testimony  is  sufficient  to  prove  its  usefulness.  This  is 
the  administration  of  full  doses  of  opium,  laudanum, 

*  I  have  known  an  exception  to  this.  In  several  cases  of  threatened 
abortion  at  the  second  month,  when  pain  and  flowing  had  already  set  in, 
the  symptoms  were  permanently  arrested  by  a  wine  glass  of  Jiot  gin  and 
water.  Did  the  juniper  act  as  a  Homoeopathic  remedy  in  these  cases? 


220  HALE   ON   ABORTION. 

or  morphine  (the  former  are  said  to  be  most  efficient), 
as  soon  as  possible  after  the  appearance  of  the  symp- 
toms. The  dose  of  laudanum  usually  prescribed,  is 
from  twenty  to  forty  drops.] 

Should  the  means  above  recommended  fail  to  arrest 
the  premonitory  symptoms,  and  those  appear  which 
indicate  a  rupture  of  the  ovum;  or  extravasation  of 
blood  between  the  membranes  and  the  uterus ;  or  the 
separation  of  the  placenta — namely,  chills,  with  more 
or  less  regular  pains  and  haemorrhage — we  may  still 
administer  remedies  in  the  hope  of  preventing  a  ter- 
mination in  actual  miscarriage.  I  consider  the  proba- 
bilities of  such  favorable  termination  as  very  small 
when  the  above  symptoms  have  set  in,  but  the  follow- 
ing remedies  may  be  tried : 

Aconite,  if  there  is  chill,  with  shivering  (rigors), 
with  anxiety,  coldness  of  the  extremities ;  sensation  of 
heaviness  in  the  uterine  region. 

Belladonna,  for  pressing  and  tensive  pains  in  the 
whole  abdomen,  with  sense  of  constriction  or  distension ; 
lumbar  pains,  as  if  the  sacrum  would  break ;  pressure 
downward  in  the  abdomen  and  pelvic  organs,  as  if 
everything  would  fall  out. 

Caulophyllum,  when  the  pains  are  regular,  like  labor 
pains,  the  os  uteri  relaxed,  some  discharge  of  bloody 
mucus,  and  sometimes  cramps  in  the  extremities.  This 
remedy  is  particularly  useful  in  cases  of  habitual  abor- 
tion from  any  cause.  It  should  be  administered  daily 
for  a  week  before  the  period  of  the  usual  abortion,  or 
as  soon  as  any  suspicious  symptoms  appear.  It  will 
often  prevent  or  arrest  a  premature  labor  in  the  last 
months  of  pregnancy. 

Cimicifuga  is  useful  in  cases  where  the  pains  are 
similar  to  those  under  caulophyllum,  but  attended  with 


TREATMENT   OF   ABORTION.  221 

intense  headache,  as  if  the  brain  and  eyes  were  pressing 
from  within  outwards ;  soreness  of  the  uterine  region, 
relaxation  of  the  os  and  vagina.  It  is  indicated  for 
women  subject  to  rheumatism,  or  spinal  irritation,  and 
hypochondriacal  lowness  of  spirits. 

Gelseminum,  when  there  is  general  prostration  and 
rigor,  without  coldness,  with  paralytic  sensations  in  the 
extremities,  fullness  and  dullness  of  the  head,  and 
obscuration  of  vision.  The  pain  and  haemorrhage  are 
not  very  marked.  It  is  indicated  in  women  subject  to 
depressing  emotions,  and  in  cases  where  the  symptoms 
were  apparently  brought  on  by  fright  or  fear. 

Cinnamon^  if  the  haemorrhage  is  profuse  and  bright 
red,  without  other  notable  symptoms.  In  similar  cases 
wigeron  and  erechtMtes  are  indicated. 

Huta  graveolens,  when  there  is  great  prostration,  con- 
fusion of  mind  (sometimes  pain  in  the  stomach  and 
violent  retching),  double  vision,  feeble  pulse,  cold 
extremities,  twitching  in  the  limbs,  and  intense  pain  in 
the  sacral  region. 

Sabina  for  "discharge  of  dark-colored  coagulated 
blood,  pressing  and  drawing  pains,  from  the  small  of 
the  back  to  the  sexual  parts;  soft  and  flat  abdomen; 
continual  urging  to  stool,  with  diarrhoea,  nausea  and 
vomiting ;  fever,  with  shuddering  and  heat."  Also  for 
cases  accompanied  with  inflammation  of  the  small  intes- 
tines (enteritis  and  peritonitis),  jaundice,  and  excessive 
irritation  of  the  urinary  organs.  It  is  most  applicable 
to  plethoric  women,  whose  menses  are  habitually  pro- 
fuse and  painfuL 

Secale  is  most  useful  in  cases  where  the  uterine  pain 
is  constant  and  unintermitting,  and  in  which  there  is 
organic  disease :  or  deficient  vitality  of  the  uterus  with 
haemorrhage  of  black  and  thin  blood,  fear  of  death, 


222  HALE    ON   ABORTION. 

pulse  small  and  most  extinguished,  os  open  and  dilated. 
It  is  suitable  to  feeble,  exhausted,  cachectic  women  with 
disposition  to  passive  haemorrhage  or  convulsions. 

Ptckatilla  for  intermittent  haemorrhage,  recurring 
every  now  and  then  with  redoubled  violence,  accompa- 
nied with  expulsive  pains  and  discharge  of  dark  blood 
with  coagula. 

Many  other  remedies  might  be  enumerated,  especially 
those  mentioned  under  the  head  of  "Medicinal  Causes" 
each  of  which  may  in  certain  cases  be  indicated. 

Eclectic  physicians  have  great  confidence  in  aletns 
farinosa,  asserting  that  it  will  arrest  abortion,  even  after 
severe  haemorrhage  has  set  in. 

Allopathic  treatment  is  generally  worse  than  useless. 
It  may  be  summed  up  thus:  bleeding,  leeches,  cold 
applications,  astringents  internally  and  externally,  dry 
cupping  and  drugs.  There  is  one  remedy,  however, 
which  I  have  before  alluded  to,  in  use  by  that  school, 
which  seems  to  be  successfully  used,  namely — laudanum. 

"  This  remedy,"  says  Cazeaux,  "  is  one  of  the  most 
efficacious,  and  sometimes  it  alone  has  enabled  us  to 
arrest  a  labor,  whose  termination  seemed  to  be  inevit- 
able, and  thus  has  permitted  gestation  to  pursue  its 
regular  course." 

"I  cannot  refrain  from  citing  the  following  instance 
in  illustration  :  A  woman  advanced  to  three  months 
and  a  half,  was  taken  with  pains  in  the  abdomen  and 
loins,  after  a  violent  altercation  with  her  husband ;  on 
the  following  day  the  pains  augmented  and  a  little 
bloody  fluid  escaped  from  the  genital  organs;  the  pains 
still  continuing,  and  the  discharge  being  somewhat  in- 
creased, on  the  third  day  the  patient  came  on  foot  to 
the  Clinique.  I  found,  on  her  arrival,  that  the  uterine 
contraction  was  very  distinct,  the  pains  sharp,  and 
renewed  every  eight  or  ten  minutes ;  pure  blood  was 
discharging  from  the  vulva,  and  the  orifice  was  suffi- 


TKEATMEOT   OF   ABOKTIOIT.  223 

ciently  dilated  to  permit  the  finger  to  pass  readily  up  as 
far  as  the  naked  membranes.  I  administered  sixty 
drops  of  laudanum,  divided  into  three  doses,  which 
were  given  at  intervals  of  three-quarters  of  an  hour, 
and  by  the  end  of  this  time,  the  pain  disappeared, 
everything  resumed  its  natural  order,  and  the  gestation 
went  on  till  full  term."  * 

Cazeaux  says  he  might  multiply  such  cases  almost 
ad  infinitum.  Other  obstetric  writers  give  similar 
testimony  in  favor  of  opium.  In  view  of  this  we  should 
not  hesitate  to  use  it  in  cases  of  abortion  when  the  usual 
remedies  seemed  powerless.  It  is  not  strictly  Homoeo- 
pathic, but  should  be  considered  as  a  dynamico-rnechan- 
ical  remedy,  in  the  same  class  with  chloroform,  ether, 
splints  and  mechanical  appliances  generally.  It  acts 
by  producing  perfect  sedation  of  the  uterus.  It  is  as- 
serted by  some  physicians,  that  large  doses  of  gelsemi- 
num  will  have  the  same  effect,  but  it  is  not  so  manage- 
able and  reliable  as  laudanum. 

Sulphuric  acid,  in  quantities  as  large  as  can  be 
safely  borne,  is  said  to  have  been  used  very  successfully, 
but  I  have  had  no  experience  with  it,  except  in  cases 
of  haemorrhage  after  abortion. 

These  measures,  which  have  for  their  object  the 
saving  of  the  life  of  the  ovum,  must  not  be  persisted  in 
too  long.  When  the  haemorrhage  is  so  profuse  as  to 
endanger  the  safety  of  the  mother,  our  attention  must 
be  entirely  turned  in  that  direction. 

The  first  object  to  be  attained  is,  of  course,  the  arrest 
of  the  haemorrhage.  "We  will  suppose  that  all  the  medi- 
cines most  likely  to  effect  that  object,  and  which  we 
have  had  time  to  use,  have  been  tried,  and  the  os  uteri 
is  not  dilated  or  dilatable :  we  must  now  resort  to  other 
means.  The  most  important  of  these  are,  (a)  THE 

*  Braithwaite,  Part  46,  page  208. 


224  HALE   ON   ABORTION. 

TAMPON;  (b)  COLD  WATER  AND  ICE;  (c)  HOT  WATER. 
The  tampon,  when  well  applied,  acts  in  two  ways :  1st, 
by  opposing  the  escape  of  blood  externally,  thus  forcing 
it  to  coagulate,  and  consequently  to  obliterate  the 
bleeding  vessels;  2d,  by  irritating  the  womb  by  its 
contact,  thereby  determinating  its  contraction,  and 
the  expulsion  of  the  product  of  conception.  This  cir- 
cumstance, indeed,  is  one  of  the  best-founded  objections 
to  the  use  of  the  tampon  in  the  early  months  of  gesta- 
tion. But  it  appears  to  me  to  be  rather  an  advantage 
than  otherwise.  The  cessation  of  the  flooding  is  always 
a  necessary  consequence  of  the  uterine  contractions. 
The  mother's  life  is  not  bought  too  dear,  when  it  is 
saved  by  the  expulsion  of  a  foetus.  Cazeaux  asserts 
that  the  use  of  the  tampon  is  not  always  necessarily 
followed  by  abortion,  but  the  exceptional  cases  must 
be  rare.  However,  it  matters  not :  the  life  of  the 
mother  is  of  the  most  importance. 

The  tampon  should  not  be  used  after  the  sixth 
month :  even  at  the  fifth  month,  the  physician  should 
carefully  watch  the  body  of  the  uterus,  after  the  tam- 
pon has  been  applied,  to  assure  himself,  every  moment, 
that  its  volume  is  not  increasing.  There  is  but  little 
reason  to  fear  the  conversion  of  an  open  into  a  concealed 
haemorrhage  before  the  fifth  month.  Unless  there  is 
abnormal  relaxation  of  the  uterine  walls,  it  would  seem 
impossible  for  a  large  quantity  of  blood  to  accumulate 
in  that  organ.  There  is,  perhaps,  the  possible  danger 
of  an  escape  of  blood  through  the  Fallopian  tubes  into 
the  peritoneal  cavities ;  but  as  those  tubes  are  blocked 
up  during  gestation,  such  a  result  would  be  highly 
improbable. 

The  introduction  of  the  tampon  is  generally  per- 
formed in  the  following  manner :  "  Some  dossils  or 


TREATMENT   OF   ABORTION.  225 

pellets  of  charpie  are  prepared — sometimes  dry,  at 
others  smeared  with  cerate — and  the  vagina  is  then 
stuffed  with  these  gradually,  care  being  taken  to  have 
the  first  portions  applied  directly  to  the  uterine  neck : 
it  would  be  better,  perhaps,  to  connect  them  by  means 
of  a  thread,  so  that  they  can  afterwards  be  withdrawn 
more  easily.  When  the  vagina  is  filled,  some  thick 
masses  of  charpie  directly  over  the  vulva  to  sustain  the 
pellets,  and  the  whole  is  held  in  position  by  a  T  band- 
age."* (See  note,  Speculum.)  But  it  is  not  always 
that  we  have  the  time  and  opportunity  to  procure  such 
choice  material,  and  we  must  not  hesitate  to  avail  our- 
selves of  anything  which  will  answer  the  purpose.  We 
can  use  soft  linen  or  cotton  cloth  cut  in  strips  or  square 
pieces ;  a  soft  linen  or  silk  handkerchief ;  an  old  nap- 
kin ;  or  even  a  piece  of  sponge.  Strips  of  cloth,  nap- 
kins, etc.,  may  be  introduced  thus :  wet  them  in  tepid 
water,  and  placing  one  end  or  corner  against  the  end 
of  the  forefinger,  push  it  up  the  vagina  until  it  comes 
in  contact  with  the  mouth  of  the  womb ;  withdraw  the 
finger  carefully  and  push  the  rest  of  the  cloth  slowly, 
carefully,  and  by  degrees,  into  the  vagina  until  the 
canal  is  compactly  and  closely  filled. 

A  sponge  may  be  wet  with  cool  water,  or  Jiamamelis 
water,  and  pushed  up  the  vagina.  The  blood  infiltrat- 
ing into  the  pores  of  the  sponge,  soon  coagulates  and 
forms  a  voluminous  clot,  which  seals  up  the  vagina 
hermetically,  without  giving  rise,  says  Dewees,  to  any 
of  the  accidents  produced  by  the  ordinary  tampon :  be- 
sides, it  is  borne  without  inconvenience,  and  may  be 
left  there  until  the  expulsion  of  the  ovum,  although  it 
would  be  better,  says  Cazeaux,  to  remove  it  after  the 
lapse  of  a  few  hours,  to  observe  the  progress  of  the 

*  Cazeaux's  Midwifery,  page  345.  * 

15 


226  HALE    ON   ABORTION. 

dilatation,  and  then  replace  it  if  the  neck  is  still  closed. 
I  haye  never  had  much  confidence  in  the  sponge,  for 
the  reason  that  it  is  not  as  sure  to  prevent  the  escape 
of  blood  externally,  as  other  materials. 

The  colpeurynteur,  or  dilatable  india-rubber  pessary, 
may  be  used  as  a  tampon,  filled  with  air,  or  better,  with 
ice  water.  For  directions  how  to  use  this  instrument, 
see  "Treatment  of  Retroversion,"  on  previous  page; 
also  the  North  American  Journal  of  Homceopathy,  vol. 
9,  page  312. 

In  the  few  cases  in  which  I  used  the  colpeurynteur,  I 
was  not  pleased  with  its  use.  I  could  not  expand  it 
sufficiently  to  prevent  the  escape  of  blood  between  it 
and  the  vaginal  walls.  Any  tampon  should  be  re- 
moved every  six  or  twelve  hours,  and  always  within 
twenty-four,  Ifbr  the  reasons — 1st,  to  ascertain  if  the  os 
uteri  is  sufficiently  dilated ;  and  2d,  to  find  if  the  foetus, 
or  placenta,  or  both,  have  been  expelled.  As,  has 
been  stated  previously,  it  is  rare  that  serious  haemor- 
rhage occurs  before  the  expulsion  of  the  foetus,  we  shall 
generally  be  required  to  use  the  tampon  after  that  oc- 
currence. It  was  also  stated  that  the  danger  from 
haemorrhage  usually  ceased  after  the  expulsion  of  the 
placenta  (except  after  the  sixth  month),  therefore,  if 
upon  removing  the  tampon  we  find  the  foetus  and  pla- 
centa, or  placenta  alone,  attached  to  the  tampon,  or 
lying  in  the  vagina,  we  shall  not  need  to  insert  the 
tampon  again. 

With  the  use  of  the  tampon,  we  may  advantageously 
administer  such  remedies  '  as  caulophyllum,  macrotin, 
gossipium,  ei*igeron,  secale  or  opium,  in  material  quan- 
tities, or  sufficient  to  cause  expulsive  contraction. 

Cold  Water  and  Ice. — The  application  of  cold  water 
and  ice^  to  the  epigastrium,  thighs  and  uterus,  to  arrest 


TREATMENT    OF   ABORTION.  227 

haemorrhage,  is  a  very  old  practice.  The  theory  is, 
that  cold  causes  uterine  contractions,  and  also  decreases 
the  calibre  of  the  blood  vessels.  It  is  directed  to  be 
applied  in  several  ways,  namely :  by  means  of  com- 
presses wetted  in  cool  or  ice  water,  and  applied  directly 
to  the  hypogastrium  and  vulva,  or  by  a  bandage  which 
is  worn  around  the  thighs.  It  has  been  recommended 
to  use  ice  water  injections  per  vaginam,  and  even  to 
plug  the  vagina  with  pieces  of  ice.  Bags  of  pulverized 
ice  have  been  placed  upon  the  hypogastrium  directly 
over  the  uterus.  The  applications  may  each  be  resorted 
to  in  cases  where  the  exigency  seems  to  demand.  I 
prefer,  in  all  cases  prior  to  the  fifth  month,  to  use  the 
tampon ;  but  the  materials  for  a  tampon  may  possibly 
not  be  at  hand,  or  the  sensitiveness  of  the  tissues  may 
be  so  extreme  that  it  cannot  be  used,  in  which  instances 
cold  water  may  be  applied  immediately.  In  several 
cases.  I  have  used  snoiv,  applied  directly  to  the  uterine  re- 
gion, or  with  only  the  thickness  of  a  napkin  intervening, 
After  the  fifth  month,  these  applications  of  cold  water, 
etc.,  are  necessary  adjuvants  to  medicinal  remedies ; 
but  before  that  time,  I  do  not  consider  them  of  such  per- 
manent utility  as  to  warrant  us  in  depending  upon  their 
use  alone.  In  order  to  be  of  value  they  have  to  be 
continued  for  a  long  time,  or  until  the  placenta  has 
been  expelled,  during  which  time  the  woman  is  exposed 
to  injury  by  the  constant  contact  of  wet  bed-clothes. 
Many  of  the  disastrous  sequelae  of  abortion  I  believe  to 
proceed  from  the  use  and  abuse  of  cold  water. 

Hot  Water. — There  is,  however,  one  method  of  ap- 
plying water  in  cases  of  uterine  haemorrhage,  which 
appears  to  be  practical  and  scientific.  It  consists  in 
the  application  of  cloths  saturated  with  water  as  hot  as 
can  be  borne  without  pain,  applied  to  the  lower  lumbar 


228  HALE    ON    ABORTION. 

region.  This  plan  was  first  recommended  by  an  emi- 
nent English  physician,*  on  the  ground  that  hot  appli- 
cations to  the  spine  cause  contractions  of  the  arteries 
supplied  by  the  -nerves  of  that  region  of  the  spinal  cord. 
It  also  causes  contractions  of  the  uterus  in  the  same 
manner  as  dry  cupping  applied  to  the  lumbar  region. 
The  hot  applications  should  be  changed  very  often, 
and  the  loss  of  heat  prevented  by  a  covering  of  oiled 
silk. 

I  have  tested  this  plan  in  several  cases  of  uterine 
haemorrhage,  even  before  the  placenta  was  expelled.  It 
seemed  to  cause  contractions  of  the  uterus,  which  re- 
sulted in  the  arrest  of  the  flooding,  and  in  some  cases 
in  expulsion  of  the  after-birth.  In  one  case  of  advanced 
uterine  cancer,  where  the  floodings  were  frequent  and 
copious,  they  were  always  quickly  arrested  by  the 
application  of  napkins  wrung  out  of  hot  water,  and 
applied  to  the  lumbar  region. 

It  must  be  borne  in  mind,  that  all  the  above  medi- 
cinal and  mechanical  means  have  only  been  resorted  to 
because  the  os  uteri  was  not  dilated  or  dilatable ;  for  as 
soon  as  this  condition  of  the  os  is  present,  we  are  not 
justified  in  depending  on  the  above-mentioned  means. 

The  rule  to  be  adopted  in  all  cases  of  abortion,  is :  as 
soon  as  the  o»  is  dilatable  or  dilated,  so  as  to  admit  the 
index  finger,  the  blunt  hook  or  intra-uterine  placental 
forceps  should  be  used  for  the  extraction  of  the  placenta, 
or  such  other  portions  of  tJie  embryo  as  may  be  in  the 
uterus. 

In  the  early  part  of  my  practice  I  adopted  this  rule, 
and  have  always  found  it  the  best,  and  that  any  devia- 
tion from  it  resulted  in  a  protracted  and  troublesome 
case,  unless  nature  expelled  the  offending  substances.  u 

*  Braitkwaite,  1803. 


TREATMENT   OF   ABOETION.  229 

The  Hunt  liook  is  tlie  most  generally  useful  instru- 
ment. It  should  be  about  15  or  18  inches  in  length, 
with  the  hook  at  one  extremity.  An  extempore  hook 
may,  in  case  of  emergency,  be  made  with  a  piece  of 
strong  wire. 


BLU1ST  HOOK. 

The  following  is  the  best  method  of  using  the  hook. 
The  woman  lying  on  her  back,  with  the  knees  drawn 
up,  and  thighs  placed  a  proper  distance  apart  (the  pa- 
tient may  lie  on  the  side  of  the  bed,  diagonally,  or  at 
right  angles  with  the  length  of  the  bed,  as  the  physi- 
cian may  choose);  pass  the  index  finger  of  the  right 
hand  (or  left,  if  most  convenient)  np  to  the  os  uteri ; 
ascertain  if  the  finger  can  be  passed  into  the  uterine 
cavity;  if  so,  pass  the  blunt  liook  along  the  palmar 
surface  of  the  finder  until  it  reaches  the  dilated  os. 

O 

The  instrument  is  then  to  be  carefully  introduced  into 
the  interior  of  the  uterus,  unless  the  placenta  is  found 
protruding  from  the  os,  or  engaged  in  the  canal  of  the 
cervix,  when  it  is  easily  removed.  The  hook  once  in 
the  uterine  cavity,  we  may  feel  for  the  placenta  just  as 
we  would  feel  for  a  cork  in  a  bottle,  in  the  dark.  Any 
one  experienced  in  the  use  of  the  hook  will  readily  de- 
tect when  it  comes  in  contact  with  the  placenta.  When 
this  occurs,  slowly  and  carefully  draw  it  towards  the 
cervix.  When  it  arrives  at  that  point,  we  should  try 
to  bring  it  in  contact  with  the  end  of  the  index  finger, 
which  perhaps  has  not  been  withdrawn.  With  the 
point  of  the  finger  pressing  against  one  side  of  the  mass, 
the  hook  is  readily  forced  into  the  other,  and  the  whole 
extracted  easily.  Should  the  placenta  prove  too  fragile, 


230  HALE    ON    ABOKTION. 

it  \\  ill  have  to  be  extracted  in  pieces.  A  little  patience 
and  tact  will  enable  the  physician  to  get  the  whole 
away. 

It  is  often  difficult,  and  even  quite  impossible,  to  ex- 
tract the  placenta  whole,  or  in  fragments,  if  it  is  very 
fragile.  The  ordinary  blunt  hook  will  not  hold  in  the 
tissue,  but  upon  the  slightest  traction  tears  through ; 
and  this  will  occur  again  and  again,  making  the  removal 
of  the  mass  a  very  tedious  process. 

In  view  of  this  difficulty,  I  have  for  several  years 
used  an  instrument  of  my  own  invention,  which  has 
many  advantages  over  the  common  hook.  The  bent 
extremity,  instead  of  consisting  of  a  single  wire,  is 
looped,  as  will  be  seen  in  the  accompanying  cut.  The 
loop  is  about  three-eighths  of  an  inch  across,  and  this 
allows  the  instrument  to  get  a  better  hold  upon  the 
placenta,  and  traction  will  not  force  it  through  the  fra- 
gile tissue.  It  is  to  be  introduced  and  used  exactly  in 
the  same  manner  as  the  blunt  hook. 


LOOPED  HOOK. 

Tlie  Forceps. — The  intra-uterine  placenta!  forceps  is 
a  valuable  instrument  in  some  cases.  Although  not  as 
generally  manageable  and  efficient  as  the  blunt  or  looped 
hook,  there  are  many  cases  where  it  can  be  used  easily. 
It  differs  from  the  ordinary  placental  forceps  in  having 
a  longer  curve,  as  will  be  seen  by  the  accompanying 
figure.  I  do  not  consider  the  short  forceps  of  any  value 
except  in  cases  where  the  placenta  is  protruding  from 
the  os,  or  lies  in  the  vagina,  and  here  the  hook  will 
answer  every  purpose. 


TREATMENT    OF   ABORTION. 


231 


LONG  FORCEPS. 

The  method  of  introducing  the  long  forceps  is  the 
same  as  advised  for  the  blunt  hook.  The  operator 
should  be  very  careful  or  he  will  pinch  the  mucous 
membrane  of  the  vagina  or  vulva,  thereby  causing  the 
woman  much  pain.  When  the  blades  of  the  forceps  are 
in  the  cavity  of  the  uterus,  the  instrument  should  be 
carefully  opened  and  closed,  moving  it  before  each 
closure,  to  a  different  portion  of  the  interior.  When 
the  placenta  has  been  seized,  the  fact  will  be  known  by 
the  handles  of  the  forceps  not  coming  in  contact.  When 
this  occurs,  carefully  withdraw  the  instrument,  follow- 
ing the  axis  of  the  strait,  and  the  whole  or  a  portion 
of  the  placenta  will  be  discovered  by  the  finger  in  the 
vagina,  between  the  blades  of  the  forceps.  If  only  a 
portion  is  extracted,  renew  the  attempts  until  the  whole 
is  brought  away. 

If  the  os  uteri  is  well  dilated,  and  the  placenta  is  felt 
engaging  in  the  cervix,  or  presenting  at  the  os,  or  even 
remains  in  the  cavity  of  the  uterus  which  lies  low  in  the 


SHOUT  FORCEPS. 


232  HALE   ON   ABOKTION. 

pelvis,  then  i,he  short  forceps  may  be  used  with  advan- 
tage. The  directions  given  for  the  use  of  the  long,  or 
intra-uterine  forceps  apply  to  this  instrument. 

The  hook  and  forceps  may  be  used  at  any  period  of 
pregnancy,  and  always  as  soon  as  the  condition  of  the 
os  will  permit  their  introduction.  At  almost  any  pe- 
riod, their  presence  in  the  womb  excites  it  to  contractile 
efforts,  so  that  there  is^  little  or  no  haemorrhage  at  the 
time  of  their  use.  Should  we  fail  to  seize  the  placenta 
in  a  reasonable  time,  the  tampon  should  be  used,  proper 
remedies  administered,  and  the  case  left  for  twenty-four 
hours. 

It  often  happens  that  while  previous  to  the  use  of 
the  hook,  forceps  or  tampon,  uterine  pains  were  absent, 
they  afterwards  appear  and  become  expulsive.  If, 
therefore,  after  the  tampon  has  been  placed  in  the  va- 
gina, labor-like  pains  set  in,  and  after  increasing  for  a 
time  in  intensity,  suddenly  cease,  we  are  warranted  in 
believing  the  placenta  has  been  expelled.  We  may 
then  remove  the  tampon,  and  in  the  majority  of  cases, 
the  placenta  will  be  found  in  the  vagina.  We  may, 
however,  find  only  a  large  clot,  or  the  foetus,  which  in 
passing  out  of  the  uterus  has  caused  the  above  symptoms, 
but  after  the  expulsion  of  a  clot  or  foetus,  the  pains 
commence  again  after  a  few  hours,  or  less  time;  whereas 
after  the  expulsion  of  the  placenta,  pains  do  not  return, 
unless  the  patient  is  beyond  the  fifth  month,  when  they 
are  really  after-pains. 

It  has  been  mentioned,  that  in  cases  of  abortion  be- 
fore the  sixth  month,  the  danger  from  haemorrhage 
is  Iff  ore  the  expulsion  of  the  placenta  and  membranes; 
while  after  that  date  dangerous  haemorrhage  usually 
occurs  after  the  after-birth  has  been  expelled.  If  this 
statement  be  fixed  in  the  mind,  it  will  be  a  valuable 


TBEATMENT   OF   ABOETION.  233 

guide  to  the  practitioner  in  the  treatment  of  that  acci- 
dent. 

Before  the  sixth  month  'medicinal  remedies  cannot 
permanently  check  haemorrhage  previous  to  the  dis- 
charge of  the  placenta.  They  may,  for  a  time,  exer- 
cise their  specific  effect  over  the  bleeding  vessels,  but 
if  the  cause  of  irritation  remains,  the  haemorrhage  will 
soon  return.  Remedies  like  secale,  or  caulopliyllum, 
will  cause  the  uterus  to  contract  firmly  upon  the  pla- 
centa, or  force  it  into  the  canal  of  the  cervix,  but  if 
they  do  not  effect  its  expulsion,  the  flooding  will  return. 
There  is  no  safety  for  the  woman  until  the  whole  pro- 
duct of  conception  has  passed  out  of  the  uterus. 

After  the  sixth  month  severe  haemorrhage  rarely 
occurs  while  the  placenta  remains  in  the  womb,  and  it  is 
the  want  of  proper  contraction  in  that  organ  which  causes 
the  flooding.  In  this  case,  medicines  may  be  used  to 
advantage,  in  connexion  with  the  application  of  cold  or 
hot  water,  as  before  mentioned,  but  the  tampon  should 
never  be  used.  The  remedies  most  generally  useful  in 
post-partum  haemorrhage  after  the  sixth  month,  are, 
Secede,  caulopJiyllum,  macrotin,  erigeron,  ipecac,  etc. 

There  are  other  measures  which  may  be  resorted  to 
in  dangerous  and  severe  cases. 

Dry  cupping  over  the  lower  lumbar  vertebrae,  is  said 
to  cause  firm  and  persistent  uterine  contractions. 

Galvanism,  when  applied  in  a  proper  manner,  has 
been  successfully  used  in  cases  of  alarming  haemorrhage. 
One  pole  should  be  applied  to  the  os  uteri,  or  pubes — 
the  other  to  the  sacral  or  lower  lumbar  region,  and  an 
interrupted  current  passed  through  the  uterus.  Firm 
contraction  is  said  to  immediately  ensue. 

The  same  means  adopted  for  the  arrest  of  haemor- 
.  rhage  during  the  last  three  months  of  pregnancy,  are 


234  HALE   ON   ABORTION. 

the  most  useful  ones  to  facilitate  the  expulsion  of  the 
contents  of  the  uterus.  The  same  contractions  which 
expel  the  placenta  will  prove  efficient  for  the  preven- 
tion of  flooding,  if  they  continue  for  a  proper  length 
of  time. 

As  regards  the  management  of  the  after-birth  (and 
by  after-birth  is  here  meant  all  decidual  or  placental 
substances  left  after  the  expulsion  of  the  embryo  or 
foetus),  it  will  be  considered  in  a  separate  chapter. 


SECTION    VIII. 

CONDUCT    OF   THE    PHYSICIAN. 

The  medical  man  who  is  called  upon  to  attend  a  case 
of  Abortion,  occupies  a  peculiar  and  anomalous  position. 
There  are  three  classes  of  cases  with  which  he  has  to 
deal,  and  each  requires  a  different  method  of  action  on 
his  part.  The  first,  are  married  women  of  respect- 
ability, in  whom  the  abortion  has  been  brought  on  by 
accident,  or  some  of  the  diseases  mentioned  among  the 
causes  enumerated.  In  these  instances  there  is  usually 
no  hesitation  on  the  part  of  the  patient  in  admitting  to 
the  physician  the  nature  of  the  illness,  and  she  may  not 
have  any  objection  to  its  publicity  among  her  friends 
or  neighbors.  In  some  cases,  however,  women  of  sensi- 
tive minds  are  averse  to  having  a  knowledge  of  the 
character  of  the  sickness  made  known  even  to  their 
nearest  friends.  In  these  cases,  the  evident  duty  of  the 
physician  is,  if  he  has  timely  notice,  to  use  all  the 
means  at  his  disposal  to  save  the  life  of  the  child  and 
arrest  the  progress  of  abortion,  if  he  can  do  so  with  per- 


TREATMENT    OF   ABORTION.  235 

feet  safety  to  the  mother ;  or,  if  called  too  late,  lie  must 
exercise  his  highest  skill  in  conducting  the  abortion  to 
a  safe  conclusion,  and  afterwards  proceed  to  effect  a 
cure  of  the  disease  (if  any  existed)  which  acted  as  a 
cause  of  the  accident. 

The  second  class  comprises  married  women  who  en- 
tertain wrong  ideas  concerning  their  duty,  and  imagine 
that  lack  of  means,  ill  health,  or  other  adverse  circum- 
stances are  sufficient  reasons  why  they  should  not  bear 
children.  This,  together  with  a  wish  to  shirk  the 
trials  and  responsibilities  of  maternity,  as  well  as  a 
desire  to  lead  easy  lives,  or  lives  of  fashion  and  luxury, 
leads  them  to  take  measures  to  prevent  the  fruit  of  con- 
ception from  reaching  maturity.  To  accomplish  this 
they  resort  to  quacks,  charlatans,  or  unprincipled  women, 
who  are  accustomed  to  induce  abortion ;  or  use  the  va- 
rious nostrums  so  shamelessly  advertised  in  many 
periodicals,  or  the  instruments  which  are  in  the  hands 
of  so  very  many  of  the  women  of  this  country.  The 
abortion  produced  by  any  of  the  above  means,  they  at- 
tempt to  endure  the  suffering,  and  risk  the  danger, 
rather  than  call  a  physician  and  thereby  have  their 
criminal  conduct  known  to  the  medical  attendant,  or 
their  own  family.  Such  patients,  when  they  do  call  a 
physician,  attempt  to  hide  from  him  the  real  nature  of 
the  malady,  and  hope  that  he  will  treat  the  case  suc- 
cessfully without  a  knowledge  of  the  actual  nature  of 
the  case.  They  will  call  it  a  dysmenorrhoea,  an  injury 
from  a  fall,  etc.,  or  a  simple  menorrhagia,  and  it  re- 
quires considerable  tact  to  ascertain  from  them  the 
facts. 

In  these  cases,  the  physician  should  come  to  no  hasty 
conclusion,  married  women  rarely  seek  aid  for  an  attack 
of  dysmenorrhoea  or  menorrhagia,  and  is  is  a  good  rule 


236  HALE   ON   ABORTION.^ 

to  suspect  the  occurrence  of  an  abortion  when  called  to 
attend  such  alleged  cases.  If  the  woman  denies  that 
there  is  any  haemorrhage,  as  they  will  often  do,  or  de- 
clares the  attack  to  be  colic  or  dysentery,  then  the 
trouble  of  detecting  the  real  disease  is  much  more  diffi- 
cult. But  the  facts  being  ascertained,  (see  "  Examina- 
tion of  the  Patient,")  the  causes  of  the  abortion,  as  well 
as  the  symptoms  present  should  all  be  taken  into  ac- 
count, and  the  case  treated  as  above  advised. 

The  third  class  are  those  unfortunate  women,  married 
and  unmarried,  the  victims  of  the  seducer,  or  of  their 
own  perverted  passions,  who  have  stepped  aside  from 
the  paths  of  virtue,  and  with  the  frailty  which  pertains 
to  humanity,  transgressed  the  laws  of  God  and  man. 
In  such  cases  the  honorable  physician  is  placed  in  a 
very  delicate  and  trying  position.  The  patient  has 
perhaps  applied  to  him  to  rid  her  of  the  consequences 
of  her  sinful  conduct,  but  upon  his  refusal  to  do  a  crim- 
inal act  she  has  resorted  to  some  of  the  unlawful  means 
mentioned  above,  and  brought  about  the  impending  or 
actual  abortion.  In  such  cases  it  is  difficult  to  decide 
what  should  be  the  conduct  of  a  physician  in  one  res- 
pect :  namely,  should  he  attempt  to  arrest  the  abortion, 
and  thereby  bring  the  mother  to  inevitable  shame  and 
save  the  life  of  an  illegitimate  child,  whose  unnatural 
parentage  will  be  a  disgrace  all  through  life  ?  Probably 
the  best  and  most  consistent  conduct  for  the  physician 
to  adopt,  should  be  to  simply  let  outraged  nature  take 
her  own  course,  and  only  interfere  by  warding  off  those 
symptoms  which  threaten  the  life  of  the  mother. 

In  relation  to  the  conduct  of  the  physician  during 
and  after  the  abortion  I  have  a  few  suggestions  to 
make.  There  is  a  great  lack  of  the  proper  honor  and 
delicacy,  regarding  a  mention  of  such  accidents,  both  with 


TKEATMENT   OF   ABOKTION.  237 

physicians  and  others.  It  is  -common  for  nurses,  friends 
and  physicians  to  say,  that  "  Mrs.  A.  or  B.  has  '  slipped 
up"'  or  to  allude  to  the  accident  in  some  such  vulgar 
manner.  The  unwarranted  impertinence  of  neighbors, 
who  insist  upon  knowing  the  nature  of  every  woman's 
illness,  is  another  reprehensible  habit.  It  forces  the 
physician  to  equivocate  or  divulge  his  patient's  secret. 
The  rule  which  should  be  invariably  adopted  by 
every  medical  man,  is  this :  Whether  in  or  out  of  Jiis 
patient's  room,  during  her  illness  or  after,  no  matter  what 
her  condition  in  life,  character  or  standing  in  society,  in 
short,  under  any  circumstances  whatever,  he  should  avoid 
all  mention  of  the  occurrence  of  an  abortion  in  his  patient. 
If  people  are  so  devoid  of  good  breeding  as  to  ask  im- 
pertinent questions,  he  is  justified  in  equivocating  to 
the  extent  of  blinding  the  questioner. 


SECTION    IX. 

EXAMINATION   OF  THE   PATIENT. 

To  physicians  who  have  had  much  experience  in  the 
treatment  of  abortion,  I  need  not  dilate  on  the  impor- 
tance of  ascertaining  as  soon  as  possible  that  an  abor- 
tion is  impending  or  in  progress,  nor  need  I  mention 
the  almost  insuperable  difficulty  which  exists  in  some 
cases,  of  satisfying  ourselves  during  our  first  visits, 
whether  the  above  accident  is  what  we  are  called  to 
treat. 

Patients  belonging  to  the  first  class  previously  men- 
tioned, rarely  cause  us  any  trouble,  but  will  frankly  say 
to  the  medical  attendant,  "Doctor,  I  am  threatened 


038  HALE   ON   ABORTION. 

with  an  Abortion  and  would  like  to  have  you  arrest  it 
if  possible,"  or  "  I  am  having  a  miscarriage."  This 
class  will  often  intelligently  acquaint  us  with  the  history 
of  the  case,  the  present  and  previous  symptoms,  and 
submit  sensibly  to  all  necessary  examinations  for  the 
purpose  of  ascertaining  the  real  condition.  As  there  is 
al ways  more  or  less  nervous  agitation  attending  such 
cases,  manifesting  itself  especially  when  the  physician 
is  present,  a  few  directions  may  not  be  amiss  to  the 
student  or  young  practitioner. 

As  it  is  customary  for  the  messenger,  if  it  is  some 
relative,  to  acquaint  the  physician  with  the  nature  of 
the  illness,  it  is  to  be  supposed  he  will  learn  something 
of  the  nature  of  the  case,  either  with  or  without  direct 
questioning,  in  which  case  he  will  feel  somewhat  pre- 
pared to  meet  his  patient.  Upon  entering  the  room,  after 
some  brief  salutations,  he  should  quietly  take  a  seat  by 
the  bedside  of  the  woman,  and  place  his  fingers  upon  her 
wrist.  Meanwhile  the  state  of  the  pulse  and  the  ap- 
pearance of  the  patient  may  be  noted.  If  the  pulse  is 
weak  or  thready  and  the  face  and  lips  blanched,  it  is 
presumed  that  severe  haemorrhage  has  occurred ;  if,  on 
the  contrary,  the  pulse  is  full,  hard  or  normal,  and  the 
face  red  or  natural,  there  is  irritative  fever,  general  re- 
action, or  only  the  premonitions  of  abortion,  or  actual 
abortion  in  the  early  months.  We  must  not,  however, 
judge  too  hastily,  as  the  mental  excitement  of  the 
patient  may  cause  a  suffused  face  and  quick  pulse. 

Generally  the  first  appropriate  question  to  the  pa- 
tient or  her  nurse,  is  :  "  When  did  this  illness  begin  ?" 
next  "What  have  been  the  symptoms  until  now?" 
There  are  instances,  however,  where  the  evident  ex- 
sanguification  should  impel  us  to  ask  at  once,  "  How 
long  has  she  been  flooding  ?"  In  some  cases  even,  it 


TREATMENT   OP   ABORTION.  239 

will  be  found  absolutely  necessary,  without  asking  a 
single  question,  to  state  to  the  patient  or  nurse  what 
must  be  done,  call  for  material  for  a  tampon  and  use  it 
immediately,  and  then  ply  the  patient  with  active 
stimulants. 

So  soon  as  the  immediate  danger  is  over,  or  an  abor- 
tion is  ascertained  to  be  progressing,  the  physician 
should  inquire  if  the  foetus  and  placenta  have  been  ex- 
pelled. This  is  a  point  upon  which  the  closest  inves- 
tigation is  necessary.  We  are  often  informed,  that 
"  every  thing  has  come  away,"  when  in  fact  the  patient 
or  her  nurse  has  seen  only  the  foetus  and  clots  of  blood, 
or  perhaps  nothing  but  a  mass  or  masses  of  coagula. 
Not  one  patient  or  nurse  in  a  thousand  ever  examines 
sufficiently  the  expelled  substances.  The  foetus  and 
after  birth,  at  an  early  stage,  may  be  passed,  enveloped 
in  large  coagula,  and  altogether  escape  superficial 
scrutiny,  or  neither  may  be  present,  yet  are  supposed 
to  be  from  the  general  appearance  of  the  mass. 

It  often  becomes  necessary  to  have  the  substances 
extruded,  produced,  that  we  may  examine  carefully 
their  character.  Each  clot  should  be  broken  and  its 
interior  examined  for  embryo  or  placenta.  If  we  can- 
not satisfy  ourselves  on  this  point,  we  must  rest  in  un- 
certainty until  an  examination  can  be  made.  If  one 
fact,  however,  is  borne  in  mind,  it  will  greatly  aid  us 
in  forming  our  opinion,  namely,  before  the  sixth  month 
hcemoi*rhag$  rarely,  if  ever,  occurs,  after  the  placenta  is 
eacpelled.  The  expulsion  of  the  foetus  alone,  only  causes 
a  subsidence  of  the  pains  for  a  time ;  it  does  not  have 
any  influence  over  the  arrest  of  haemorrhage. 

We  have  supposed  cases  where  the  abortion  was  ad- 
mitted, or  was  evident  at  first. 

The  second  and  third  classes  are  more  difficult  to  treat, 


240  HALE   ON   ABOETION. 

because  of  the  obstacles  thrown  in  the  way  of  a  proper 
knowledge  of  the  case. 

A  physician  is  called  to  see  a  woman.  He  has  no 
intimation  of  the  nature  of  her  illness.  She  is  said  to 
be  in  "  great  pain  "  or  "  very  sick."  She  says  to  him, 
4<  I  want  relief  from  the  pain  across  me,"  or  "  I  have  a 
colic."  She  will  state  it  is  from  a  cold,  and  assert  that 
it  was  from  a  suppression,  or  intimate  that  she  has  been 
regular,  and  the  attack  is  only  dysmenorrhoeal.  A 
woman  who  has  determined  to  hide  her  shame  will  use 
every  subterfuge  that  cunning  and  equivocation  can 
devise.  She  will  deny  the  presence  of  flooding,  even 
when  her  exsanguined  appearance  plainly  indicates  the 
fact.  The  character  of  the  pain  will  be  an  indication 
to  the  watchful  physician.  But  an  ordinary  colic  is 
often  intermitting,  as  also  are  the  pains  of  dysmenor- 
rhcea  or  dysentery. 

The  only  way  we  can,  in  some  cases,  arrive  at  a  cor- 
rect diagnosis,  is  to  seem  to  assent  to  the  assertions  of 
the  patient,  while  we  are  questioning  in  relation  to 
symptoms  which,  while  they  seem  unimportant  to  her, 
are  valuable  indications  to  us.  When  we  are  satisfied 
than  an  abortion  is  in  progress  or  impending,  we  should 
not  hesitate  to  acquaint  the  patient  with  our  convic- 
tions, in  a  courteous  but  decided  manner.  Instances 
are  not  rare,  where  careless  or  ignorant  physicians  have 
attended  cases  of  abortion  during  the  first  half  of  gesta- 
tion, under  the  idea  that  they  were  cases  of  enteralgia, 
enteritis,  dysmenorrhcea,  or  even  dysentery ;  the  woman 
succeeding  perfectly  in  hiding  the  evidences  of  the  mis- 
carriage. Every  physician  should  be  on  the  alert  and 
not  allow  himself  to  be  caught  in  such  a  mortifying 
predicament.  Finally,  in  an  examination  of  a  patient, 
it  should  be  remembered,  that  no  matter  what  her  social 


TREATMENT    OF   ABORTION.  241 

condition,  her  character,  or  the  character  of  those 
around  her,  the  sick-room  is  no  place  for  unseemly  or 
rude  jests.  No  coarse  allusions  or  indelicate  remarks 
should  be  indulged  in  or  allowed  by  the  physician.  No 
one  having  any  regard  for  manly  or  professional  dignity 
will  countenance  such  conduct.  All  manual  examina- 
tions should  be  conducted  with  delicacy  and  gentleness, 
without  any  unnecessary  exposure  of  the  patient.  If 
instruments  are  used,  all  unnecessary  nourish  and  exhi- 
bition should  be  avoided,  for  these  are  the  tricks  of 
quacks  and  ignorant  pretenders. 


SECTION   X. 

MANAGEMENT    OF   LABOR.' 

"  Abortion,"  says  Professor  Hodge,  "  is  a  true  labor. 
The  two  characteristic  peculiarities  are — first,  that  there 
is  no  placenta,  but  the  whole  membrana  decidua  is  in 
close  and  vascular  connection  with  the  internal  surface 
of  the  uterus."*  .Dr.  Hodge  restricts  the  term  abortion 
to  an  expulsion  of  the  ovum  before  the  fourth  month, 
after  which  period  the  placenta  is  formed,  and  the  deci- 
dual  membranes  are  separated  from  the  uterine  surfaces. 

The  practitioner,  when  called  to  attend  an  abortion, 
should  go  prepared  to  meet  any  emergency  which  may 
arise.  If  he  neglects  this,  and  the  woman  dies,  or  suf- 
fers from  dangerous  symptoms  which  might  have  been 
remedied  by  the  proper  medicines  and  instruments,  he 
is  culpable  in  the  highest  degree  for  his  criminal  care- 
lessness or  ignorance. 

*  System  of  Obstetrics,  page  464. 

16 


242  HALE   ON   ABORTION. 

He  should  take  with  him,  besides  his  ordinary  pocket- 
case  of  remedies,  some  crude  ergot  freshly  prepared,  or 
a  reliable  vinous  tincture ;  or  the  first  decimal  tritura- 
tion  of  caulophyllin;  some  oil  of  erigeron,  TV ;  a  blunt 
hook,  or  abortion  forceps ;  and  a  piece  of  charpie,  or  a 
sponge,  to  use  as  a  tampon.  If  the  physician  has  a 
well-regulated  office,  all  these  can  be  collected  in  a 
moment.  Their  possession  may  be  of  invaluable  ser- 
vice to  him,  and  enable  him  to  save  the  life  of  his 
patient,  and  his  own  reputation,  both  of  which  might  be 
lost  while  a  messenger  was  riding  miles  away  to  procure 
the  articles  desired. 

The  treatment  of  the  premonitory  symptoms  has 
already  been  laid  down ;  also  the  treatment  of  the 
symptoms,  such  as  haemorrhage,  etc.,  which  may  occur 
during  the  progress  of  an  abortion. 

The  management  proper  of  the  different  stages,  will 
now  be  considered. 

If,  upon  examination,  the  os  is  found  closed,  no 
haemorrhage,  and  no  change  taken  place  in  the  body  of 
the  uterus,  except  some  descent  of  that  organ  in  the 
pelvis,  and  some  unusual  turgescence  and  fullness  of  the 
pelvic  viscera,  such  as  simple  organic  irritation  would 
cause ;  the  physician  can  do  no  more  than  to  prescribe 
the  appropriate  remedy  for  the  condition,  and  give  the 
proper  directions  relating  to  diet  and  posture,  and  leave 
the  patient  for  the  time.  (See  Treatment,  page  218). 
If,  however,  nervous  irritation  or  contraction  has  ensued, 
and  the  neck  of  the  uterus  is  found  developed  at  the 
tipper  part,  it  will  indicate  a  partial  descent  of  the 
ovum  into  the  canal  of  the  cervix.  If  this  occurs,  the 
conical  form  of  the  lower  portion  of  the  uterus  will  be 
found  considerably  altered — it  will  have  become  more 
spherical.  Dr.  Lee  states  that,  in  all  such  cases,  expul- 


TREATMENT    OF   ABOETION.  243 

sion  will  surely  follow.  This  termination  will  be  still 
more  probable  if,  in  addition,  the  os  uteri  is  found  par- 
tially dilated,  and  especially  if  a  portion  of  the  ovum 
be  found  protruding.  There  are  cases,  however,  espe- 
cially in  multiparous  women,  where  the  internal  os 
remains  contracted,  while  the  external  is  soft  and  some- 
what patulous.  In  these  instances,  if  alternate  pains  be 
not  severe,  there  is  ground  for  hope  that  the  ovum  will 
be  retained. 

If,  with  the  above  condition,  there  is  still  no  haemor- 
rhage, the  patient  may  be  left  as  before,  under  the  use 
of  the  remedies,  etc.,  appropriate  to  the  symptoms  and 
state.  The  remedies  indicated  are — -gelseminum,  cimici- 
fuga,  caulopJiyllum,  gossipium  and  secale,  from  the  3rd 
dilution  upwards.  It  is  in  this  condition  that  full  doses 
of  opium  have  been  found  most  useful  by  the  old  school, 
and  also  even  when  haemorrhage  is  present.  (See  case, 
page  223). 

The  best  position  for  the  patient  to  assume,  is  on  the 
back,  with  the  hips  elevated,  unless  in  case  of  retrover- 
sion,  when  the  woman  should  lie  on  the  face.  Again, 
if  it  be  positively  ascertained  that  the  ovum  is  blighted, 
that  the  liquor  arnnii  is  evacuated,*  that  the  haemor- 
rhage is  profuse,  and  regular  alternating  pains  are 
established,  and  especially  if  the  measures  for  preven- 
tion have  been  inefficient,  the  practitioner  should  favor, 
not  retard,  the  expulsive  process;  and,  at  the  same 
time,  render  it  as  easy  and  as  safe  as  possible. 

In  this  place  I  must  advert  to  my  division  of  utero- 
gestation  into  three  stages,  for  the  management  of  this 
expulsive  stage  of  abortion,  must  be  varied  with  each 
stage  of  pregnancy. 

*  This  occurrence  is  rare  at  the  early  months,  as,  in  a  great  number  of 
cases,  the  ovum  is  discharged  entire  ;  and  in  all  instances  the  quantity  of  the 
amniotic  fluid  is  so  small  that,  when  discharged,  it  escapes  notice. 


244  HALE   OX    ABORTION. 

In  the  first  stage,  it  is  rare  that  we  find  much  dilata- 
tion of  the  os  uteri,  or  can  find  the  embryo  presenting. 
Should  we  detect  the  embryo  engaged  in  the  canal  of 
the  cervix,  or  even  in  the  vagina,  it  is  not  best  to  re- 
move it,  for  its  presence  in  either  canal  may  be  useful 
in  exciting  uterine  contractions ;  while  its  removal  can 
do  no  good,  but  rather  retard  the  progress  of  labor.  Its 
presence  in  the  cervical  canal  may  also  be  useful  in 
preventing'hgemorrhage,  acting  as  a  plug.  We  should 
not  leave  the  woman  in  this  condition,  without  placing 
a  tampon  in  situ,  for  fear  that  haemorrhage  occurs  in 
our  absence.  The  presence  of  the  tampon  will  be  of 
sn-vice,  too,  in  hastening  the  termination  of  the  expul- 
sive process. 

The  delivery  of  the  after-birth,  or  secundines,  which, 
in  this  stage  of  pregnancy,  consist  only  of  the  decidual 
membranes,  is  the  most  important  duty  of  the  physi- 
cian. It  is  difficult  to  accomplish  this  with  the  ordinary 
wire  crochet,  or  blunt  hook,  owing  to  the  delicacy  of 
the  membranes,  and  their  general  adherence  to  the 
uterine  walls.  Neither  can  we  rely  upon  those  uterine- 
motor  medicines  (caidophyllin,  ergot^  etc.)  for,  in  this 
stage,  the  contractile  power  of  the  uterus  is  small,  owing 
to  the  undeveloped  condition  of  its  muscular  tissue. 

We  must  either  allow  them — if  not  thrown  off  by  the 
efforts  of  nature — to  decay,  and  pass  away  in  a  fluid 
state,  or  extract  them  by  instrumental  means  other 
'than  the  hook.  The  intra-uterine  placental  forceps, 
to  which  I  have  alluded  on  another  page,  may  be  used ; 
or  the  "  abortion  forceps,"  originally  recommended  by 
Levret,  or  Hodge's  forceps,  "  the  blades  of  which,"  he 
says,  "  are  so  arranged  that  they  may  present  the  form 
of  a  lever,  allowing  their  easy  introduction  through  the 
cervix  'into  the  uterus,  exterior  to  the  ovum."  (It  is 


TREATMENT    OF    ABORTION.  245 

only  in  the  third  month,  or  after,  however,  that  such  an 
an  instrument  can  be  used.)  But,  probably,  the  instru- 
ment best  adapted  to  remove  the  contents  of  the  uterus, 
if  the  os  and  cervix  are  dilated  so  as  to  admit  the  finger, 
is  the  "  abortion  vectis,"  which  I  have  invented.  It  is, 
it  is  true,  only  a  modification  of  Hodge's  "  lever  and 
crotchet,"  but  it  is  specially  adapted  for  the  removal  of 
the  embryo  in  this  fo&  stage.  The  lever  and  crotchet 
combined,  is  better  adapted  for  use  in  the  second  stage. 


ABORTION  VECTIS. 

The  abortion  vectis  can  be  insinuated  into  the  uterus, 
betwen  the  embryo  and  the  uterine  parietes,  and,  with 
careful  oscillating  movements,  we  may  separate  the  ovum 
from  its  adhesions,  and  generally  withdraw  it  entire. 
So  soon  as  this  is  accomplished,  haemorrhage  and  pain 
will  cease,  and  the  abortion  is  at  an  end.  If,  however, 
even  a  small  portion  of  the  membrane  is  left  in  the 
womb,  it  will,  in  certain  constitutions,  act  as  a  local 
irritant,  keeping  up  pain  and  haemorrhage,  until  it  has 
disintegrated  and  passed  off;  or,  its  absorption  may 
cause  irritative  fever,  which  must  be  treated  with 
sulphite  of  soda,  laptisia,  arsenicum,  or  chlorate  of 
potash,  internally,  together  with  injections  of  chlorate 
or  per-manganate  of  potash-,  or  baptisia,  into  the  interior 
of  the  uterus,  to  wash  away  the  offending  substance, 
and  act  as  a  local  disinfectant.  The  instrument  best 
adapted  for  this  purpose  is  a  hard  rubber  syringe, 
holding  two  ounces,  and  provided  with  an  extra  long 
and  slender  pipe. 


046  HALE    ON    ABORTION. 

If  the  abortion  occurs  during  the  second  stage  of 
pregnancy,  the  management  of  the  labor  differs  some- 
what from  that  of  the  first  stage.  The  delivery  of  the 
embryo-fetus  should  be  left  to  nature,  as  recommended 
in  the  first  stage,  and  for  the  same  reasons,  the  delivery 
of  the  placenta  and  membranes  may  have  to  be  as- 
sisted in  a  somewhat  different  manner.  After  the 
third  month  the  placenta  is  perfect,  and  is  attached 
to  the  uterus,  while  at  the  same  time  the  decidua 
ceases  to  be  in  such  contact  with  the  uterine  wall  as 
in  the  previous  stage,  the  circulation  between  the 
mother  and  child  being  carried  on  solely  through  the 
placenta. 

In  this  stage,  abortion  may  occur  with  complete 
detachment  of  the  whole  placenta  at  once,  in  which 
case  the  embryonic  mass  drops  into  the  lower  segment 
of  the  uterus,  and  may  be  expelled  entire,  as  in  the 
first  stage.  Oftener,  however,  the  membranes  are  rup- 
tured, and  the  foetus  escapes  while  the  placenta  retains 
its  connections.  In  other  cases  we  may  have  ab- 
normal adherence  of  the  placenta,  in  which  instance  the 
contractions  of  the  uterus,  though  sometimes  quite 
powerful,  are  insufficient  to  detach  it.  Here  the 
"abortion  vectis"  will  form  a  valuable  instrument,  if 
the  os  is  open  sufficiently  to  admit  of  its  introduction. 
After  it  has  been  detached,  however,  the  blunt  or 
looped  hook  or  forceps  will  form  the  best  instrument 
for  its  extraction. 

If  the  os  is  not  sufficiently  dilated  we  may  use  the 
tampon,  and  give  gelseminum  or  belladonna  until  dila- 
tion occurs.  We  may  then  have  to  administer  caulo- 
phyllin,  or  ergot,  the  former  in  doses  of  two  to  four 
.grains  of  the  Tvth,  the  latter  in  the  officinal  dose  given 
from  time  immemorial — namely,  one  drachm  to  a  tea- 


TREATMENT   OF   ABORTION.  -.  247 

cup  of  hot  water,  taken  at  four  draughts  fifteen  minutes 
apart.  Those  who  think  the  3rd  or  30th  attenuation 
will  answer  as  well  are  allowed  their  opinion. 

An  adherent  placenta,  remaining  in  spite  of  the 
efforts  of  nature  or  art,  is  supposed  to  be  the  -origin  of 
molar  or  hydatid  masses.  But  it  quite  often  happens 
that  the  whole  placenta  undergoes  putrefactive  disin- 
tegration, or  the  portions  left  after  instrumental  inter- 
ference, decay  ;  in  which  case  we  may  have  foetid  dis- 
charges and  irritative  fever,  previously  alluded  to  and 
treatment  given. 

The  management  of  labor  after  rthe  sixth  month 
(third  stage  of  pregnancy),  is  essentially  the  same  as 
recommended  for  labor  at  full  time  (see  standard  works 
on  Obstetrics).  I  will  only  add  a  few  observations  to 
refresh  the  memory  of  the  practitioner,  namely : 

The  expulsion  of  the  ovuin  may  here  be  aided  by 
the  internal  use  of  uterine  motor  excitants  ;  by  instru- 
ments; and  by  remedies  Homoeopathic  to  non-relax- 
ation of  the  os  and  soft  parts. 

The  delivery  of  the  placenta  may  be  aided  by  trac- 
tion with  the  cord  (which  cannot  be  done  in  the  earlier 
months),  by  caulopliyllin,  ergot,  etc.;  and  by  the  instru- 
ments heretofore  named. 

The  haemorrhage  must  be  arrested  with  ergot,  cold 
water,  galvanism,  dry  cupping,  erigeron,  the  tight  band- 
agejletc.,  as  recommended  in  cases  of  natural  labor. 

Here  the  tampon  should  never  be  used,  nor  those 
remedies  recommended  for  haemorrhage  during  the 
first  stage.  They  are  not  often  adapted  to  the  patho- 
logical state  upon  which  post-partum  flooding  depends, 
and  will  generally  prove  insufficient. 


24  S  HALE   ON   ABORTION. 

SECTION    XI. 

SEQUELAE     OF     ABORTION. 

The  post-partum  treatment  of  abortion,  although  not 
of  the  same  importance  as  the  remedial,  is  a  subject 
which  should  be  fully  considered.  I  believe  it  has  not 
received  that  attention  from  physicians  which  the  sub- 
ject demands. 

The  post-partum  treatment  may  be  properly  divided 
into 

(a)  Postural. 

(f)  Dietetic. 

(<:•)  Medicinal. 

(e)  Mechanical. 

The  postural  treatment  is  altogether  too  much  neg- 
lected by  a  great  majority  of  physicians. 

It  is  too  often  the  case  that  a  patient  who  has  had 
an  abortion  during  the  first,  or  even  second  stage  of 
pregnancy,  is  allowed  by  the  attendant  to  rise  from  her 
bed  the  next  day,  or  a  few  days  thereafter,  and  attend 
to  her  household  duties  or  recreations.  I  have  known 
women  engage  in  severe  work  or  exercise,  or  attend 
parties  or  balls,  but  a  few  days  after  an  abortion  irr  the 
second  month.  The  physician  has  a  responsibility  in 
this  matter.  It  is  his  duty  to  state  to  the  patient,  her 
nurse,  or  certain  members  of  the  family,  the  importance 
of  the  recumbent  posture  for  a  certain  length  of  time 
after  the  delivery.  This  period  varies  somewhat  with 
the  period  of  pregnancy  in  which  the  abortion  has 
occurred. 


TREATMENT   OF  ABORTION.  249 

It  depends,  too,  in  a  great  measure,  upon  the  severity 
of  the  symptoms  during  the  progress  of  the  abortion, 
and  upon  the  constitution  and  morbid  conditions  of  the 
patient. 

Abortion  in  the  'first  stage  of  pregnancy  is  rarely 
attended  with  great  loss  of  blood,  the  pain  is  not  very 
severe,  and  consequently,  the  strength  of  the  woman 
is  not  much  exhausted.  But  an  engorged  condition  of 
the  uterus  is  generally  present,  and  if  the  woman  is  too 
soon  and  too  often  on  her  feet,  or  sits  up  too  much,  the 
womb  is  inclined  to  sink  into  the  pelvis,  and  a  pro- 
lapsus or  retroversion  ensues. 

If  the  abortion  has  been  short  in  its  duration,  and 
the  symptoms  few  and  not  severe,  confinement  to  the 
bed  or  couch  need  not  continue  more  than  four  or 
five  days.  If,  however,  getting  up  and  standing  or 
walking  for  an  hour  or  two  causes  any  local  uneasi- 
ness in  the  back  or  abdomen,  the  recumbent  posture 
should  be  maintained  a  portion  of  the  time  for  several 
days  longer. 

If,  on  the  contrary,  the  symptoms  have  been  severe ; 
there  has  been  much  haemorrhage ;  a  slow  expulsion 
of  the  embryo,  or  its  retention  in  utero ;  or-  if  it  is 
found  on  examination  that  the  uterus  or  its  cervix  is 
congested,  or  the  os  lacerated  or  abraded,  explicit 
directions  should  be  given  not  to  allow  the  patient  to 
sit  up  or  stand  on  her  feet  more  than  a  minute  or  two 
at  a  time  until  eight  or  ten  days  have  expired.  The 
woman  who  leaves  her  bed  under  these  circumstances 
before  that  time,  does  so  at  the  imminent  hazard  of  her 
future  health,  and  perhaps  her  life. 

During  the  second  period,  the  postural  treatment  of 
patients  who  have  aborted  is  of  still  greater  impor- 
tance. As  it  approaches  the  sixth  month,  confinement 


250  HALE   ON   ABOKTION. 

becomes  more  and  more    hazardous,  and  its  sequelae 
more  like  those  of  labor  at  term. 

Haemorrhage,  when  it  occurs,  is  more  apt  to  be  pro- 
fuse and  exhausting,  the  labor  more  tedious  and  dan- 
gerous, and  the  after  treatment  more  important.  It  is 
believed  by  practical  and  observing  physicians  that 
cancer  of  the  uterus,  ulceration  of  the  os  and  cervix, 
chronic  inetritis,  prolapsus  and  retroversion,  frequently 
occur  from  a  too  early  assumption  of  the  erect  position 
after  abortion  in  the  middle  period  of  gestation.  In 
nearly  every  case,  should  the  symptoms  appear  ever  so 
slight  and  unimportant,  the  woman  should  keep  her 
bed  for  a  week  after  the  labor  has  been  completed. 
There  are  certain  cases,  however,  where  the  placenta  is 
retained;  but  the  patient  improves  in  strength  and 
health  notwithstanding.  The  placenta  may  not  be 
expelled  for  weeks  after  the  woman  has  left  her  bed, 
no  decay  or  putrefaction  having  taken  place.  In  these 
cases,  we  cannot,  of  course,  confine  the  patient  to  her 
bed  until  its  expulsion  occurs,  nor  would  it  be  proper 
to  do  so. 

If  severe  haemorrhage,  congestion,  or  inflammation, 
or  irritative  fever  has  occurred,  the  patient  should  on 
no  account  get  up  until  the  twelfth  day,  even  if  she 
feels  perfectly  able  to  do  so.  In  these  instances,  how- 
ever, the  woman  has  not  the  power  of  rising,  even  if 
she  desires  to,  such  is  the  local  pain,  general  weakness, 
vertigo,  etc.,  which  is  caused  by  the  effort. 

If  the  accident  has  occurred  during  the  last  three 
months  of  pregnancy,  nearly  the  same  rules,  last  men- 
tioned, should  govern  us  in  our  postural  treatment. 
The  same  direction  should  be  given  as  would  be 
proper  after  delivery  at  the  ninth  month,  as  the  patho- 


TREATMENT    OF   ABOKTION".  251 

logical  conditions  which  ensue  are  nearly  the  same  as 
at  the  latter  period. 

Dietetic.  —  The  diet  of  the  patient  who  has  suffered 
an  abortion  is  not  an  unimportant  item.  Its  character 
will  depend  on  the  condition  of  the  system.  If  fever 
is  present,  due  to  any  local  inflammation,  the  aliment 
should  be  very  light,  easily  assimilable,  and  bland. 
Toast  water,  rice  gruel,  flour  or  farina  porridge,  light 
toast  or  crackers,  together  with  cooling  beverages,  will 
be  best  relished  by  the  patient,  and  most  appropriate. 
If  the  fever  is  irritative,  from  local  irritation  or  the 
absorption  of  morbid  matters  into  the  circulation,  the 
food  allowed  should  be  of  a  more  nutritious  character. 
Milk,  rice,  toast,  animal  broths,  beef-tea,  wine  and 
whey,  cocoa,  etc.,  may  be  allowed.  The  physician 
should  be  careful  to  form  a  correct  diagnosis  in  these 
cases,  and  not  mistake  the  irritable  pulse  of  this  con- 
dition for  the  quick,  hard  pulse  of  fever  from  inflamma- 
tion. 

If  the  patient  has  lost  much  blood,  or  been  greatly 
reduced  by  the  length  of  the  illness,  or  prostrated  by 
the  irritative  fever  which  has  attended  it,  the  diet  will 
have  to  be  not  only  exceedingly  nutritious,  but  suffi- 
ciently stimulating.  We  shall  be  under  the  necessity 
of  ordering  milk-punch,  egg-nogg,  beef-tea,  mutton-broth, 
soups,  all  such  meats  as  the  patient  can  relish,  and 
allow  her  to  take  them  in  such  quantities  as  her  condi- 
tion requires.  It  is  very  necessary  in  these  cases  to 
give  the  nutriment  at  short  intervals.  If  food  is  given 
every  two  or  three  hours,  the  quantity  taken  will  be 
less,  and  the  stomach  is  not  so  liable  to  be  overloaded. 
Dr.  Inman  states  that  he  has  seen  cases  where  it  was 
necessary  to  administer  to  the  patient  concentrated 
nutriment  every  hour,  in  order  to  prevent  dangerous 


252  HALE    ON    ABORTION. 

prostration.  It  is  hardly  necessary  to  caution  against 
allowing  indigestible  articles  of  diet,  among  which  may 
be  mentioned  raw  apples  or  other  uncooked  fruits, 
pickles,  salt  meats  or  fish,  pastry,  confectionery,  etc. 
In  this  category  might  be  placed  ice-cream,  were  it  not 
that  this  article  is  often  allowable,  especially  in  cases 
of  great  prostration  or  irritative  fever,  where  there  is 
present  great  thirst,  dryness  of  the  mouth,  and  a  desire 
for  cooling  drinks.  It  may  be  given  in  small  quanti- 
ties, a  spoonful  at  a  time,  and  allowed  to  be  slowly 
melted  in  the  mouth.  If  taken  in  too  large  quantities, 
or  too  hastily,  it  may  give  rise  to  colic  and  even 
spasms. 

The  medicinal  treatment  of  the  sequelae  of  abortion 
will  depend  upon  the  nature  of  the  pathological  condi- 
tion, and  the  symptoms  present. 

These  sequelae  have,  the  most  of  them,  been  de- 
scribed, and  their  treatment  given,  in  that  part  of  this 
work  devoted  to  the  causes  and  their  treatment.  There 
are  other  maladies,  which  are  not  mentioned ;  but  which 
properly  belong  to  the  consequences  of  abortion.  They 
are,  pelvic  cellulitis ;  hypertrophy  of  the  uterus ;  fis- 
tula3,  (vesical,  uterine,  or  between  the  organs  alluded 
to)  ;  adhesions  of  the  os  and  vagina,  rendering  liable 
subsequent  rupture  of  the  womb  during  labor  or  from 
retained  menses,  or,  in  the  latter  case,  discharge  of  the 
secretion  through  the  Fallopian  tubes  and  consequent 
peritonitis ;  and,  finally,  inflammation  of  the  mammae, 
puerperal  inetritis,  phlebitis,  dropsy,  and  paralysis  of 
the  lower  extremities.  Others  might  be  named;  but 
it  would  swell  the  list  to  an  extent  incompatible  with 
the  limits  of  this  treatise. 

The  medicinal  treatment  of  these  sequelae  will  be 
briefly  alluded  to. 


TREATMENT   OF   ABORTION.  253 

Pelvic  cellulitis  will  require  those  remedies  which 
favor  resolution  or  healthy  suppuration,  namely :  Mer- 
curius,  belladonna,  Jiepar  sulph.,  and  phytolacca.  In 
some  cases  the  abscess  will  have  to  be1  punctured  to 
give  vent  to  the  pus,  which,  if  confined,  would  burrow, 
and  create  troublesome  complications. 

Hypertrophy  of  the  Utei-us. —  I  have  observed  in 
many  cases  of  abortion  before  the  sixth  month,  a  large 
increase  in  the  size  of  the  abdomen  in  the  hypogastric 
region.  It  was  not  ascites,  for  external  examination  failed 
to  detect  the  fluctuation  found  in  dropsy,  and  moreover 
the  urinary  secretion  was  normal  in  quantity.  An 
examination  of  the  uterus  showed  it  to  be  much 
enlarged — often  much  larger  than  before  the  abortion. 
I  believe  this  to  be  a  serous  infiltration  into  the  uterine 
parieties,  superadded  to  that  condition  which  Professor 
Simpson  has  described  as  u  Sub-involution  of  the  Uterus." 

I  have  treated  such  cases  successfully  with  sepia, 
arsenicum,  kali  bromatum  and  Teali  hydi*iodicum. 

Fistulw,  adhesions,  etc.,  will  require  the  attention  of 
the  skillful  surgeon ;  but  they  may  be  prevented  by 
proper  attention  on  the  part  of  the  physician,  who,  if 
he  has  the  least  fear  of  such  consequences,  should 
make  occasional  examinations,  and  by  placing  a  dilator 
in  the  os,  or  pledgets  of  lint  in  the  vagina,  prevent 
such  evils. 

Inflammation  of  the  Mammce.  When  the  abortion 
has  occurred  after  the  third  month,  it  is  not  unusual 
for  milk  to  be  secreted.  When  this  happens  it  will  be 
necessary  to  arrest  the  secretion  as  soon  as  it  can  be 
safely  done.  This  end  is  best  attained  by  prescribing, 
for  internal  remedies,  kali  hydriodatum,  phosphorus  and 
magnesia  sulphurica ;  and  externally  embrocations  of 
aconite-water  (3j  to  3j),  phytolacca,  belladonna,  or 


254  HALE   ON   ABORTION. 

iodide  of  potash,  in  ointment  or  solution.  If,  from 
neglect,  or  in  spite  of  these  means,  inflammation  and 
abscess  supervene,  adopt  tlie  treatment  herein-before 
recommended. 

Puerperal  metritis  will  require  veratrum  viride,  bella- 
donna,  stramonium,  cimicifuga,  and  external  applica- 
tions of  aconite. 

Puerperal  peritonitis,  the  same  remedies.  (This  dis- 
ease is  not  of  such  frequent  occurrence  as  is  believed. 
It  is  often  confounded  with  myalgia,  which  requires 
caulophyllum,  nux  vomica,  cimicifuga,  helonias,  china 
bryonia,  and  colocynth,  with  external  applications  of  a 
lotion  of  gelseminum  or  arnica). 

Phlebitis  calls  for  arnica,  belladonna,  and  hamamelis, 
—  the  latter  externally  applied  if  possible. 

Dropsy  after  abortion  is  removed  by  apocynum  can- 
nabinum,  eiipatorium  purpureum,  apis  mel.,  canthai*is, 
senecio  aureus,  and  arsenicum. 

Paralysis  of  the  lower  extremities  will  yield  to  cau- 
lophyllum, hedeoma,  nux  vomica,  ignatia,  citrate  of  iron 
and  strychnia,  secale,  and  msculus  glabra. 

Mental  aberrations  are  not  uncommon  after  abortions, 
and  may  proceed  from  reflex  influences,  or  from  grief 
or  remorse.  These  will  require  careful  symptomatic 
treatment.  One  of  the  best  remedies  for  the  mental 
depression  following  abortion  is  the  cimicifuga,  which 
has  been  successfully  used  by  Professor  Simpson,  and 
lately  by  myself. 

One  of  the  most  common  of  the  sequelae  of  abortion 
is  premature  and  profuse  menses.  They  sometimes 
occur  every  three  weeks ;  sometimes  eveiy  two  weeks. 
Although  sabina,  ipecac,  sulphur,  and  platinum  are  fre- 
quently indicated  and  successful,  I  have  been  most  suc- 
cessful, in  fact  in  nearly  every  case,  with  senecin  and 


TREATMENT   OF   ABORTION.  255 

calcarea  carl.  In  these,  as  in  some  other  instances  in 
o.ur  practice,  neither  seems  to  be  as  useful  alone,  as 
when  used  in  alternation. 

I  usually  prescri^the  senetin  in  the  second  decimal 
trituration,  a  dose  every  afternoon  and  evening,  and  a 
single  dose  of  calcarea,  third  trituration,  every  morn- 
ing. ^ 

It  is  best  to  give  these  remedies,  beginning  just  after 
the  last  menstrual  period,  and  continuing  them  until 
the  next  regular  period,  unless  the  menses  are  prema- 
ture, in  which  case  they  may  be  superseded  by  ipecac 
or  sabina  during  the  flow. 

It  is  rare  that  the  second  period  will  be  premature 
after  beginning  the  use  of  the  above  remedies. 

Chronic  menorrhagia  of  a  very  obstinate  character 
sometimes  follows  an  abortion.  It  may  arise  from 
atony  of  the  uterus,  from  irritability,  or  from  a  condi- 
tion of  the  lining  membrane,  described  by  some  writers 
as  consisting  of  an  enlarged  and  hypertrophied  state  of 
the  villous  coat,  —  a  kind  of  fungous  growth  of  its  pa- 
pillae, from  which  blood  oozes  upon  the  least  irritation. 

For  atonic  conditions,  we  should  use  helonias,  trillium, 
secale,  aletris,  terebinth,  sulphuric  add,  and  sabina,  in 
the  lower  dilutions. 

For  irritation,  sabina,  caulophyllum,  platina,  etc.  The 
last  cause  of  menwrhayia  can  only  be  cured  by  abso- 
lute rest  and  a  long  course  of  treatment,  with  carefully 
selected  remedies,  among  which  may  be  mentioned 
erigeron,  secale,  trillium,  cole.,  senecio,  china,  ferrum, 
pulsatilla,  etc.,  unless  we  resort  to  local  applications  to 
the  diseased  surface,  applied  with  the  intra-uteiine 
syringe. 

Several  cases  have  occurred  in  my  practice,  which 
persisted  for  many  months,  notwithstanding  the  use 


256  HALE   ON   ABORTION. 

of  all  the  most  approved  medicines  recommended  for 
menorrkagia,  until  topical  means  were  resorted  to. 
One  case  I  cured  with  injections  of  tinctura  ferr.  muri- 
atis,  10  drops  to  §j  of  water,  halAf  which  was  used 
once  a  day.  After  the  third  Jty,  the  haemorrhage 
ceased,  and  did  not  return.  In  another  case  the  per- 
nitrate  of  iron,  was  used  successfully. 

The  mechanical  treatment  includes  those  appliances 
which  will  serve,  to  prevent  the  occurrence  of  uterine 
displacements,  or  the  closure  of  the  vagina  or  os  uteri 
by  adhesions. 

A  prolapsus  may  be  prevented  or  cured  by  the  same 
means,  together  with  cool  injections  containing  hama- 
melis,  nux  voinica,  or  Jielonias,  the  use  of  cool  hip  baths, 
and  the  hypogastric  bandage. 

For  the  prevention  of  adhesions,  the  vagina  and 
uterus  should  be  examined,  in  cases  where  excoriation 
or  laceration  is  supposed  to  have  occurred,  to  ascertain 
if  the  vaginal  and  cervical  canals  are  normally  open.  The 
finger  will  do  to  explore  the  former,  the  sound  the  latter. 
If  a  closure  is  to  be  found,  pledgets  of  lint,  or  pieces  of 
linen  spread  with  calendula  cerate  on  both  sides,  should 
be  introduced  and  kept  in  situ  till  the  danger  has 
passed  by. 

For  retrovei'sion  I  do  not  hesitate  to  use  the  closed 
lever  pessary  or  the  ring,  as  seems  best  indicated,  and 
have  thus  prevented  in  many  cases  the  uterus  from 
assuming  a  retroverted  condition,  which  it  had  attained 
previous  to  the  abortion. 

In  my  pamphlet  on  Retroversion  and  Retroflexion  of 
the  Uterus  (page  2),  I  alluded  to  the  fact  that  that 
form  of  displacement  was  a  frequent  cause,  accompani- 
ment, and  consequence  of  abortion.  I  advert  to  it 


TREATMENT   OF   ABORTION.  257 

again  because  the  subject  is  too  important  to  be  lost 
sight  of  by  the  practical  physician. 

As  a  cause  of  abortion,  it  has  been  fully  treated  of  in 
the  foregoing  pages.  As  an  accompaniment,  I  did  not 
mention  it  to  the  extent  I  intended  to  do.  A  flexed  or 
retroverted  uterus  is  one  of  the  chiefest  obstacles  to  the 
natural  expulsion  or  extraction  of  the  placenta  or  any 
of  the  products  of  an  arrested  conception.  Coagula  of 
blood  even  are  sometimes  retained  a  long  time  in  the 
cavity  of  the  uterus  from  this  cause  alone. 

When  the  foetus  dies,  or  the  membrane  becomes  de- 
tached from  the  womb,  that  organ  sinks  in  the  pelvis, 
and  if  any  tendency  to  retroversion  exists,  that  accident 
is  pretty  sure  to  occur.  In  this  case  the  expelling  power 
of  the  uterus  is  altogethe,r  destroyed,  and  it  strives  with 
unavailing  efforts  to  throw  off  its  contents.  A  single 
glance  at  the  anatomical  peculiarities  of  the  uterus  will 
show  us  how  futile  these  efforts  must  be.  A  hollow, 
pear-shaped  musale  is  flexed  at  its  neck,  or  almost 
doubled  upon  itself.  In  this  condition  the  severest 
spasmodic  action  of  its  muscular  tissue  becomes  utterly 
useless.  I  have  known  the  most  intense  spasmodic 
pains  to  continue  day  after  day,  weary  the  patient  out, 
and  no  good  result  until  the  uterus  was  replaced  and 
kept  in  a  normal  position  until  the  offending  placenta 
was  expelled.  A  case  which  occurred  in  my  practice 
not  long  since,  so  aptly  illustrates  this  subject,  that  I 
cannot  forbear  giving  it.  A  delicate,  nervous  woman, 
who  had  had  several  miscarriages,  attended  wfth  retro- 
version,  for  which  she  had  been  treated  by  several 
physicians  of  eminence  in  our  school  came  under  my 
care..  On  one  occasion,  she  had  lain  several -weeks  with 
a  retained  placenta,  from  retroversion,  suffering  in  the 
meantime  from  metritis,  spasmodic  pains,  etc.,  until 
17 


258  HALE   ON   ABORTION. 

the  uterus  was  held  in  its  proper  position  by  a  ring 
pessary,  when  the  placenta  came  away  in  a  horribly 
putrid  state  of  semi-liquid  putrescency. 

In  the  instance  in  which  she  came  under  my  care, 
the  foetus  (of  three  months)  was  expelled ;  the 
pains  ceased  for  nearly  a  day,  but  returned  severely 
after  she  had  imprudently  made  considerable  effort  at 
stool.  After  the  pains  had  lasted  several  hours,  I  was 
called,  and  found  them  very  agonizing  and  spasmodic. 
On  examination,  the  uterus  was  found  almost  completely 
retro  verted.  Not  having  with  me  a  sound,  I  left  some 
mother  tincture  of  caulophyllum,  ten  drops  to  be  taken 
every  half  hour  until  I  returned.  Not  getting  relief 
in  two  hours,  she  took,  on  her  own  responsibility,  a 
tea-spoonful  of  the  tincture  at  a  single  dose.  The  pain 
ceased  altogether  in  fifteen  minutes !  This  action  of 
caulopJiyllum  should  not  surprise  us,  for  it  is  secondarily 
Homoeopathic  to  spasm,  in  which  case  we  know  it 
often  requires  massive  doses  to  prove  curative.  On 
getting  on  her  feet  again,  however,  the  pain  returned 
with  its  original  intensity.  On  my  arrival,  the  uterine 
sound  was  with  much  difficulty  introduced,  and  with 
considerable  effort  the  uterus  was  lifted  into  normal 
position.  Knowing  that  it  would  become  retroverted 
immediately  if  the  sound  were  withdrawn,  I  introduced 
a. curved  elastic  pessary  while  the  sound  was  still  in  the 
uterus.  This  can  be  done  by  any  one  familiar  with 
the  former  instrument.  The  sound  was  then  with- 
drawn, and  the  uterus  elevated  as  much  as  possible. 
Ergot  was  given  in  the  usual  manner,  and  the  placenta 
was  expelled  in  less  than  two  hours.  All  pain  ceased, 
and  the  pessary  was  allowed  to  remain  for  eight  days, 
when  the  patient  was  discharged. 

There  have  been  several  cases,  which  I  was  obliged 


TREATMENT   OF   ABORTION.  259 

to  treat  in  the  same  manner,  and  in  view  of  the  uniform 
success  which  has  attended  the  method,  I  do  not  hesi- 
tate to  advise  the  insertion  of  the  elastic  cwved  or  ring 
pessary,  in  every  instance  of  retained  placenta  from 
retroversion. 

It  will  sometimes  happen  that  this  form  of  displace- 
ment will  not  occur  until  after  the  abortion  has  fully 
terminated  with  the  complete  discharge  of  the  foetus, 
placenta,  and  membranes.  The  patient  gets  up  too 
soon,  and  the  effort  of  standing,  or  straining  at  stool,  or 
lifting,  causes  the  heavy  fundus-uteri  to  fall  backward. 
The  attending  physician  should  warn  his  patient  of 
the  nature  and  probable  occurrence  of  the  accident,  and 
the  means  to  avoid  it.  She  should  be  instructed  to 
report  if  certain  symptoms  obtain,  that  immediate 
measures  for  relief  may  Ibe  taken.  As  soon  as  the  dis- 
placement is  known  to  have  occurred,  the  physician 
should  enjoin  the  recumbent  position,  replace  the  organ 
by  means  of  the  processes  hereinbefore  described,  and 
place  the  patient  upon  the  use  of  iodide  of  iron,  podo- 
phyllum,  nux  vomica,  Jielonias,  or  belladonna,  until  the 
danger  of  a  recurrence  of  the  accident  is  passed. 


PART   V. 


OBSTETRIC    ABORTION. 


OBSTETRIC    ABORTION.  263 


SECTION    I. 

OBSTETRIC    ABORTION. 

It  would  be  a  manifest  omission,  and  detract  largely 
from  the  value  of  this  work,  were  I  to  leave  out  of  it  a 
full  consideration  of  the  subject  of  obstetric  abortion, 
namely :  the  conditions  under  which  it  is  proper  and 
necessary  that  labor  should  be  brought  on  before  the 
ninth  month. 

I  shall  proceed  to  treat  of  this  subject  in  three  divi- 
sions, which  will  correspond  with  the  three  divisions 
of  utero-gestation  which  I  have  heretofore  described. 

First.  The  Various  methods  in  use  to  cause  expulsion 
of  the  contents  of  the  gravid  uterus,  after  the  sixth 
month,  and  before  the  time  for  the  normal  termination 
of  pregnancy.  This  is  designated  as  premature  labor. 

Second.  The  methods  adopted  to  bring  about  the 
same  results  during  the  middle  period  of  gestation,  or 
from  the  end  of  the  third  to  the  end  of  the  sixth  month. 
This  is  termed  foetal  abortion. 

Third.  The  methods  which  may  be  used  during  the 
firafe  three  months  after  conception.  This  is  embryonic 
abortion. 

The  abormal  conditions  which  make  it  necessary  to 
resort  to  these  operations  will  be  mentioned. 

(1)  Premature  Labor. 

'  The  subject  of  premature  labor  cannot,  in  a  work  of 
this  scope,  be  more  than  briefly  mentioned.  Every 
physician  is  supposed  to  have  in  his  library  the  works 


264  HALE   OX    ABORTION. 

of  the  most  eminent  obstetricians,  in  which  will  be  found 
all  the  information  required  on  this  point. 

Premature  labor  is  an  operation  by  which  the  lives 
of  both  mother  and  child  may  be  saved,  It  is  only 
admissible  to  resort  to  it  in  cases  where  the  child  can- 
not be  born  alive  unless  by  the  dreadful  operations  of 
the  Cesarian  section  or  symphyseotomy,  both  of  which 
endanger  the  life  of  the  mother  in  the  highest  degree ; 
also  in  cases  where  delivery  is  only  possible  by  enibry- 
ulcia,  or  the  extraction  of  tli*  foetus  by  fatal  mutila- 
tion. r 

Premature  labor  is  restricted  to  that  period  subse- 
quent to  the  "  viability  "  of  the  foetus.  This  period  is 
technically  included  within  the  last  three  months  of 
pregnancy.  There  is  but  little  hope,  however,  that  a 
child,  born  in  the  sixth  month  of  gestation,  will  sur- 
vive, although  cases  are  on  record  where  children 
have  lived  at  six  months.  At  the  seventh  month  chil- 
dren often  live,  and  quite  generally  in  the  eighth. 

The  necessity  for  the  induction  of  premature  labor 
arises  mainly  from  a  disproportion  between  the  passages 
of  the  pelvis  and  the  size  of  tfie  head  of  the  child  at  the 
full  period  of  utero-gestation.  At  this  time,  it  may  be 
presumed  that  the  bi-parietal  diameter  of  the  foetus 
measures  at  least  three  inches  and  four  lines,  and  there- 
fore a  living  child  can  hardly  be  born,  even  by  aid  of 
forceps,  unless  there  be  three  and  a  quarter  inches  in 
the  short  diameter  of  the  pelvis.  Embryotomy,  or 
some  other  operation,  would  be  the  alternative. 

The  same  declaration  applies  to  other  sources  of  ob- 
struction than  simple  deformity,  as  in  cases  of  exostosis, 
of  ovarian  and  other  tumors  in  the  pelvis,  of  indurated 
or  contracted  vagina,  and  in  those  also  of  permanent 
induration,  thickening  or  scirrhous  of  the  os  and  cervix 


OBSTETEIC    ABOKTIOtt.  265 

uteri,  or  where  there  are  fibrous  "or  steatomous  tumors 
in  the  lower  segment  of  the  uterus,  so  located  or  so 
large  that  the  delivery  at  term  would  be  impracticable. 
Also,  it  may  be  applicable  in  cases  where  successive 
pregnancies  have  demonstrated  that  the  child  is  born 
dead  in  consequence  of  the  size  of  the  head,  and  its  very 
complete  state  of  ossification. 

To  estimate  as  nearly  as  possible  at  what  period  labor 
should  be  induced,  the  practitioner  should  examine  care- 
fully, 

First,  As  far  as  practicable,  the  degree  of  deformity 
or  obstruction  which  exists ;  and, 

Secondly,  The  usual  length  of  the  bi-parietal  diame- 
ter during  the  last  three  months  of  utero-gestation. 

The  modes  of  measuring  the  degree  of  deformity  of 
the  pelvis  will  be  found  detailed  in  the  standard  works 
on  obstetrics. 

v  As  regards  the  diameters  of  the  child's  head,  the  fol- 
lowing tables,  prepared  by  M.  Figueira  and  Ritgen, 
will  afford  a  proximate  idea  of  the  length  of  the  diame- 
ters at  the  different  periods  of  gestation ;  although  great 
allowances  must  be  made  for  the  relative  development 
of  different  children,  the  uncertainty  of  the  exact 
periods  of  conception,  and,  of  course,  of  the  stage  of 
pregnancy,  and  for  the  flexibility  or  compressibility  of 
the  foetal  head,  so  that  a  cranium  apparently  too  large 
may  or  can  be  often  safely  delivered.. 

Measurement  of  the  bi-parietal  diameter  according  to 

Figueira : 

In.  Lines.. 

At  7th  month, 2  9 

"  7J       «      3 

«  8th     "       3  1 

"  8|       "      3  2 

"  9th     "                               ....  3  4 


266  HALE   ON   ABORTION. 

According  to  Ritgen,  labor  may  be  induced  at  the 

In.L. 

29th  week,  or  6£  month,  when  the  antero-posterior  diam.  is  2     7 
20th      "        6|      "  «  "  "  "28 

81st       "        7th    "  "  "  "  "29 

35th      "        8th    "  "  "  "  "      2  10 

36th      «        8J      "  "  "  "  "      2  11 

37th      "        8|      "  "  "  "  "       3  — 

The  best  writers  on  obstetrics  do  not  hesitate  to 
assert,  that,  if  the  antero-posterior  diameter  of  the  brim 
be  three  inches  and  six  lines,  it  will  be  justifiable  to 
induce*  labor  prior  to  the  full  period  —  that  it  will  be 
better  for  the  mother,  and  far  safer  for  the  infant. 

Besides  the  above,  which  may  be  termed  mechanical 
obstructions  to  labor  at  full  time,  there  is  another  class 
of  cases  where  the  induction  of  premature  labor  is  called 
for  on  account  of  the  foetus  alone.  There  are  cases, 
where,  from  some  diseased  condition  of  the  placenta, 
the  child  dies  in  utero  before  the  end  of  the  ninth 
month.  These  diseases  have  been  mentioned  in  previ- 
ous chapters.  There  are  other  cases  where  the  child 
dies  during  parturition,  owing  to  a  premature  detach- 
ment of  the  placenta  and  consequent  haemorrhage  dur- 
ing labor.  The  remedy  for  such  conditions  is  premature 
labor  at  a  time  prior  to  that  at  which  the  death  of  the 
foetus  has  usually  occurred. 

There  is  still  another  class  of  cases  where  disease  of 
the  mother  makes  the  operation  justifiable,  —  namely, 
vomiting,  chorea,  mania,  albuminaria,  disease  of  heart 
and  lungs,  debility,  etc. 

Vomiting. — Under  the  inhuman  belief  that  the  life 
of  the  child  should  be  saved  at  the  risk  of  that  of  the 
mother,  women  have  been  suffered  to  die  from  the  effects 
of  severe  and  protracted  vomiting,  or  left  to  drag  out  a 


OBSTETRIC    ABORTION.  267 

life  of  misery  with  chronic  gastritis,  or  ulceration  of  the 
stomach.     Several  obstetric  writers  claim  that  the  in- 
duction of  abortion  is  never  necessary  from  this  cause. 
Opposed  to  these,  we  have  the  testimony  of  Dubois, 
Stoltz,  and  others,  who  assert  that  this  is  oftener  a  dan- 
gerous occurrence  than  is  supposed.    M.  Dubois  recently 
stated  before  the  Academy  of  Medicine*  that,  in  the 
course  of  thirteen  years,  he  had  met  with  twenty  cases 
in  which  vomiting  proved  fatal  to  pregnant  women. 
Professor  Stoltz  of  Strasburg  relates  four  cases  which 
came  under  his  observation.     In  three  of  these  death 
occurred,  and  life  was  saved  by  the  operation  in  the 
fourth,  although  the  case  seemed  hopeless.     M.  Dubois 
refers  to  the  fact,  that,  when  the  process  of  gestation 
becomes  arrested,  whether  spontaneously,  or  not,  vom- 
iting is  ordinarily  put  an  end  to,  although  the  wroman 
may  not  be  delivered  for  several  days  after  of  a  dead 
child,  and  may  yet  die  of  the  effects  of  what  she  has 
already  undergone.      Women,  apparently  at  the  point 
of  death,  have  been  saved  by  the  spontaneous  death  of 
the  foetus,  this  being  expelled  only  some  time  afterward. 
There  can  be  no  doubt  of  the  moral  propriety  of  ter- 
minating gestation  in  certain  cases  of  vomiting.     "  The 
difficulty,"  says  M.  Dubois,  "is  to  fix  the  period  at 
which  this  should  be  resorted  to ;  for  it  is  the  natural 
desire  to  delay  this  as  long  as  possible,  which  delay  often 
leads  to  a  fatal  result,  the  woman  dying  in  fact  from  the 
exhaustion  and  prolonged  abstinence,  which  the  vomit- 
ing has  produced,  prior  to  the  operation  for  arresting 
it  being  undertaken."  Stoltz  lays  great  stress  upon  the 
operation  being  performed  in  good  time,  because  if  we 
wait  until  the  effects  of  the  sympathetic  reaction  con- 
stitute in  themselves  a  serious  disease,  the  evacuation 

*  Bulletin  de  1'Acad.,  torn,  xvii.,  pp.  557-582. 


268  HALE   ON   ABORTION. 

of  the  womb  does  not  induce  a  cessation  of  these,  and 
may,  in  certain  cases,  even  hasten  death,  —  life,  so  to 
say,  hanging  upon  a  thread.  It  is  undoubtedly  difficult 
to  say  when  the  moment  has  arrived  that  we  can  no 
longer  hope  for  benefit  from  nature  or  therapeutical 
agents.  In  Homoeopathic  practice,  much  may  be  reason- 
ably expected  of  the  latter ;  but  their  use  should  not  be 
insisted  upon  too  long.  M.  Dubois  lays  it  down  as  a 
rule,  "  Never  to  undertake  the  operation  when  the  signs 
of  extreme  exhaustion  are  present,  as  evidenced  by  con- 
siderable loss  of  vision,  cephalagia,  comatose  somnolence, 
and  disorder  of  the  intellectual  faculties.  On  the  other 
hand,  we  should  also  abstain  from  operating  when  the 
vomiting,  though  violent  and  frequent,  still  allows  of 
some  aliment  being  retained ;  when  the  patient,  though 
wasted  and  feeble,  is  not  obliged  to  keep  her  bed ;  when 
the  suffering  has  not  yet  induced  intense  and  continu- 
ous febrile  action ;  and  when  other  means  still  remain 
untried,  In  the  first  case  we  would  not  save  our  pa- 
tient, but  perhaps  accelerate  her  death,  and  bring  dis- 
credit on  the  operation ;  while  in  the  other  we  would 
sacrifice  a  pregnancy  which  might  have  gone  on  till  the 
full  time.  It  is  therefore  the  intermediate  period  which 
should  be  chosen,  and  this  is  characterized  by  the  fol- 
lowing signs:  —  1.  Almost  incessant  vomiting,  by  which 
all  alimentary  substances,  and  sometimes  the  smallest 
drop  of  water,  are  rejected.  2.  Wasting  and  debility, 
which  condemn  the  patient  to  absolute  rest.  3.  Syn- 
cope, brought  on  by  the  least  movement  or  mental 
emotion.  4.  A  marked  change  in  the  features.  5.  Se- 
vere and  continuous  febrile  action.  6.  An  excessive 
and  penetrating  acidity  of  the  breath.  7.  The  failure 
of  all  other  means.  But  even  within  this  period,  which 
is  of  variable  duration,  the  opportune  moment  must  be 


OBSTETRIC   ABOETION.  269 

chosen.  This  seems  to  have  arrived  when  the  inefficacy 
of  the  most  approved  treatment  has  been  proved,  when 
fever  is  found  to  persist,  and  the  debility  and  wasting 
of  the  patient  are  making  sensible  progress.  The  at- 
tendant should  now  declare  that  the  operation  is  indi- 
cated, leaving  the  patient  and  her  friends  the  duty  of 
deciding  upon  its  adoption." 

I  should  consider  it  an  unjustifiable  procrastination 
for  the  physician  to  wait  until  some  of  the  above  con- 
ditions had  obtained.  The  life  of  a  woman,  a  wife,  a 
mother,  is  too  precious  to  be  sacrificed  to  any  mistaken 
sense  of  duty. 

Many  methods  of  inducing  premature  labor  have  been 
practised.  The  earliest  plan  adopted  was  that  of  punc- 
turing the  membranes.  At  first  a  quill  was  used, 
sharpened  at  the  point ;  afterwards  a  stillette,  or  stil- 
letted  catheter,  was  used.  This  is  sometimes  described 
as  a  canula,  with  a  trocar  sheathed  in  its  cavity.  The 
method  of  operating  with  this  instrument  is  as  follows : 


STILLETTE. 

Place  the  patient  on  her  back,  near  the  side  of  the 
bed,  or  better,  in  the  position  usually  adopted  for  the 
operation  of  "  turning,"  (at  right  angles  with  the  length 
of  the  bed,  with  tfae  hips  near  the  edge,  and  the  thighs 
flexed).  With  the  index-finger  of  th®  right  hand,  find 
the  os  uteri— the  point  of  the  instrument,  with  the  tro- 
car or  stillete  sheathed,  is  moved  along  the  palmar  sur- 
face of  the  finger  until  it  reaches  the  os,  when  to  is  to 
be  insinuated,  up  through  the  canal  of  the  cervix,  into 
the  interior  of  the  uterus.  The  extent  to  which  the 
point  is  made  to  enter  the  uterine  cavity  depends  alto- 


27"  HALE   ON   ABORTION. 

gether  upon  the  period  of  pregnancy.  When  it  has 
reached  the  proper  position  (against  the  membranes) 
the  stillette  is  to  be  protruded,  when  it  will  enter  and 
puncture  the  membranes.  I  cannot  advise  the  use  of 
this  instrument  in  any  stage  of  pregnancy,  as  it  is  best 
in  all  cases  to  retain  the  membranes  intact  as  long  as 
possible.  The  only  exception  to  this  rule  is,  in  cases 
where  the  membranes  are  punctured  high  up,  in  the  last 
months  of  pregnancy.  But  in  this  instance,  a  au/rved 
canula  is  used,  and  the  waters  escape  very  slowly.  I 
prefer,  however,  other  methods  to  this. 

The  improper  use  of  the  stillette,  in  the  hands  of  the 
ignorant  and  reckless,  has  diused  sudden  death.  One 
case  came  under  the  observation  of  Dr.  P.  H.  Hale.  A 
woman  procured  a  stillette  of  a  "  nurse,"  who  gave  her 
directions  how  to  use  it.  She  introduced  the  instru- 
ment as  far  into  the  uterus  as  possible,  then  protruded 
the  sharp  point  nearly  two  inches  with  considerable 
force.  She  immediately  fainted,  and  never  rallied  from 
the  collapse.  Death  took  place  in  less  than  half  an  hour 
after  the  injury.  There  was  no  flooding.  No  post- 
mortem was  allowed.  The  husband,  who  was  in  the 
room  at  the  time,  did  not  approve  of  the  operation 
which  the  woman  attempted  to  perform.  She  took  the 
risk,  and  paid  for  her  criminality  with  her  life.  This 
is  only  one  of  many  instances  where  the  woman  uses 
such  instruments  against  the  will  of  the  husband.  This 
evgry  physician  will  bear  witness  to. 

In  the  case  above  mentioned,  How  did  the  stillette 
cause  death  so  suddenly  ?  It  is  an  interesting  question 
for  the  pathologist  to  solve. 

But  this  plan  has  of  late  years  been  discarded  as 
dangerous  both  to  mother  and  child.  It  has,  however, 
been  revived  somewhat  by  M.  Meissner,  under  another 


OBSTETRIC    ABORTION.  271 

and  better  form — namely,  puncturing  the  membranes 
high  up,  by  means  of  a  curved  stilletted  catheter  care- 
fully introduced  between  the  membranes  and  the  uterus, 
avoiding  the  site  of  the  placenta.  This  plan  has  been 
successful  in  many  instances.  T^he  waters  escape  so 
gradually  that  the  passages  become  lubricated  and  re- 
laxed, and  pains  make  their  appearance  in  the  course 
of  twenty-four  hours. 

The  sponge-tent,  invented  t>y  Kluge  is  another  plan 
frequently  adopted.  It  acts  both  as  an  irritant  and  a 
mechanical  dilator,  thus  bringing  on  labor  by  causing 
reflex  action,  and  opening  the  os  and  cervix  by  its  ex- 
pansion. It  is  used  in  the  following  manner :  Warm 
emollient  injections  are  used ;  then  the  conical  prepared 
sponge  is  carried  up  to  the  uterine  orifice  by  means  of 
a  pair  of  long  curved  forceps  (intra-uterine  forceps)  and 
is  made  to  enter  the  canal  of  the  cervix,  where  it  is 
kept  in  place  by  means  of  a  tampon  of  pieces  of  cloth, 
or  a  sponge.  If  pains  are  not  established  in  twenty- 
four  hours,  use  another  and  larger  tent.  Sometimes 
the  plan  of  M.  Meissner  is  combined  with  Kluge's  with 
good  results. 

Small  caoutchouc  bags  have  been  recommended  by 
Dr.  Barnes,  of  England,  and  used  very  successfully,  in- 
stead of  the  sponge  tent.  They  are  introduced  into  the 
canal  of  the  cervix,  and  filled  with  water.  For  full 
particulars  relative  to  this  method,  reference  is  made  to 
the  articles  on  that  method. 

"  This  instrument,"  says  Dr.  Barnes,  "  is  of  a  fiddle- 
shape,  having,  when  distended,  a  narrower  cylindrical 
central  portion,  dilating  at  either  end  into  a  bulging  or 
mushroom-like  expansion.  The  object  of  this  is  to  pre- 
vent the  bag  from  slipping  forward  into  the  uterus,  or 
backward  into  the  vagina.  The  bag  is  prolonged  into 
a  long  narrow  tube  with  a  stop-cock  at  the  end,  to  keep 


HALE   ON   ABORTION. 

in  the  water  when  injected.  The  injecting  medium  is 
the  ordinary  Higginson's  syringe  (or  ^  Essex') — an  in- 
strument which  should  always  be  carried  in  the  obstet- 
ric trosseau,  as  it  is  useful  for  many  other  purposes. 
Three  bags  of  different  sizes  are  sufficient  as  a  series/ 
To  facilitate  the  introduction  of  the  flaccid  bag  into  the 
n-rvix  uteri,  a  small  pouch  is  attached  outside  to  receive 
the  end  of  the  uterine  sound,  which,  guided  by  the 
finger  of  the  left  hand  applied  to  the  os  uteri,  sei-ves  to 
push  the  bag  into  the  cervical  canal." 

Dr.  Barnes  claims  that  by  the  use  of  these  bags,  pre- 
mature labor  may  be  induced  at  a  predetermined  hour. 
The  operation  is  entirely  within  the  control  of  the 
operator.  The  vagina  is  first  dilated  by  the  use  of 
the  colpeurynteur ;  then  the  smallest  or  medium  bag 
("  dilator")  is  introduced  into  the  cervix,  care  being 
taken  that  the  terminal  bulging  part  shall  pass  through 
the  os  uteri  internum,  while  the  inferior  bulging  end 
emerges  in  the  vagina.  When  water  is  thrown  in,  the 
dilator  is  thus  secured  by  its  shape  in  situ,  and  the 
eccentric  pressure  bears  upon  the  whole  cervical  ca,nal, 
and  especially  upon  the  two  points  of  greatest  resist- 
ance— the  os  externum  and  internum.  This  stage  ought 
not,  as  a  mle,  to  occupy  less  than  three  or  four  hours. 
If  the  smallest  or  medium-sized  dilator  does  not  expand 
the  cervix  sufficiently,  the  largest  size  must  be  used.  If, 
when  full  dilation  occurs,  pains  do  not  set  in,  a  portion 
of  the  liquor  amnii  may  be  drawn  off,  and  the  uterus 
compelled  to  collapse.  A  portion  of  the  liquor  should 
be  left  in  to  facilitate  turning,  if  that  should  become 
necessary.  Caulopliyllin,  or  ergot  may  be  used  after  full 
dilation  and  puncturing  of  the  membranes,  if  the  uterus 
seems  to  be  in  a  condition  of  inertia. 

The  tampon,  used  as  recommended  for  uterine  haem- 
orrhage, has  been  resorted  to.  It  should  be  large 


OBSTETRIC    ABORTION.  273 

enough  to  expand  the  upper  portion  of  the  vagina,  to 
such  an  extent  as  to  excite  reflex  irritation.  This  plan 
is,  however,  painful,  and  slow  in  its  operation,  and  is 
Adopted  by  but  few. 

The  colpe-uryntewr  is  often  used  to  induce  premature 
labor.  The  instrument  is  a  simple  bag  of  vulcanized 
india-rubber,  which  is  to  be  introduced  into  the  vagina, 
and  then  dilated  with  air,  warm  or  cold  water,  as  may 
be  deemed  expedient.  After  being  more  or  less  fully 
expanded  (and  it  may  be  advisable  at  first  to  grad- 
ually inflate  it,  and  increase,  as  the  pressure  is  less  and 
less  inconvenient)  the  aperture  is  closed  by  a  stop-cock, 
and  the  bag  allowed  to  remain  in  the  vagina.  A  full 
description  of  the  instrument  and  its  use  was  given  in 
the  treatment  of  retroversion.  The  meaning  of  the 
Greek  words  from  which  this  instrument  is  derived,  is 
vagina-dilator,  and  expresses  the  idea  of  the  effect  it 
produces,  dilating  the  vagina,  and  even  pulling  open 
the  os  uteri,  and  by  its  forcible  pressure  exciting,  by 
sympathy  the  action  of  the  uterus. 

The  water  douche  was  introduced  into  practice  by 
the  late  Professor  Kiwisch,  of  Wurzburg.  Tyler  Smith, 
Cazeaux  and  others,  prefer  this  method  above  all 
others,  especially  when  the  life  of.  the  child  is  an 
object.  If  a  stream  of  hot  or  cold  water  be  directed 
against,  or,  still  better,  within  the  os  uteri,  at  intervals 
of  three  or  four  hours,  for  the  space  of  ten  minutes  or  a 
quarter  of  an  hour  at  each  application,  labor  is  certainly 
and  speedily  brought  on.  The  water  may  be  made  by 
means  of  a  syphon  and  reservoir,  to  descend  upon  the 
uterus  from  a  height,  or  it  may  be  forced  into  or  against 
the  os  by  a  common  injecting  apparatus  which  is  capa- 
ble of  throwing  a  continuous  stream,  like  the  Essex 
syringe  heretofore  described. 
18 


074  HALE   ON   ABORTION. 

Kiwisch  explained  the  modus  operandi  of  the  douche 
on  the  supposition  that  it  caused  swelling  of  the  parts 
by  imbibition  of  fluid,  and  separation  of  decidua  from 
the  uterus.  Probably  the  reflex  and  peristaltic  actions 
of  the  uterus  are  also  excited.  Tyler  Smith  found  the 
douche  more  efficacious,  when  warm  and  cold  water 
were  injected  alternately,  than  when  either  warm  or 
cold  was  applied  alone.  The  great  advantages  of  the 
douche  are,  that  the  premature  labor  excited  is  more 
dertain,  and  imitates  to  a  greater  degree  natural  parturi- 
tion ;  also  it  never  injures  the  genital  organs,  the  mem- 
branes of  the  ovum,  or  the  foetus. 

Separation  of  the  memfjranes  from  the  os  and  cervix 
uteri,  by  the  catheter,  bougie,  or  sound,  is  highly 
recommended  by  Professor  Simpson,  who  is  high 
authority  in  obstetric  matters.  The  instrument  is 
oiled  and  cautiously  insinuated  between  the  membranes 
and  the  uterine  surface,  and  with  short,  gentle  move- 
ments from  side  to  side,  carried  up  towards  the  fundus 
of  the  womb.  Care  should  be  taken  that  the  placental 
vessels  are  not  ruptured.  An  ordinary  flexible  bougie, 
introduced  a  considerable  distance  between  the  mem- 
branes and  uterus,  and  allowed  to  remain,  will  cause 
premature  labor. 

This  plan  has  been  improved  upon  by  an  eminent 
obstetrician,  who  introduces  a  flexible  English  catheter, 
by  means  of  a  wire  of  sufficient  size  inside,  nearly  up  to 
the  fundus  uteri.  The  wire  is  then  withdrawn,  and  a 
quantity  of  warm  olive  oil  injected  into  the  uterus, 
through  the  catheter  by  means  of  a  syringe.  Glycerine 
or  milk  will  answer  the  purpose  as  well  as  oil.  Another 
physician  uses  a  flattened  female  catheter,  to  which  is 
attached  a  common  injecting  syringe,  and  after  its  in- 
troduction between  the  membranes  and  the  uterine 


OBSTETRIC    ABORTION.  275 

wall,  a  quart  of  tepid  water  is  injected,  slowly,  so  as 
to  act  by  gradually  separating  the  membranes. 

A  syringe,  having  a  very  long,  slightly  flexible  tube 
of  hard  rubber  twelve  or  fifteen  inches  in  length,  would 
be  preferable,  as  there  would  be  no  necessity  for  the 
introduction  of  the  catheter.  Two  openings  in  the  end 
of  the  tube,  at  its  sides,  would  be  better  than  the  usual 
orifice  in  the  end.  The  amount  of  fluid  thrown  up  at 
once  should  not  exceed  two  or  three  ounces.  Its  ope- 
ration is  to  separate  the  membranes  over  a  large  surface, 
and  at  the  same  time  excite  the  reflex  and  peristaltic 
actions  of  the  uterus. 


INTRA-UTERINE    SYRINGE. 

The  administration  of  &rgol  is  recommended  by 
Dr.  Ramsbotham,  but,  as  it  seems  to  us,  upon  insuf- 
ficient grounds.  The  majority  of  obstetricians  are 
opposed  to  its  use,  and  those  who  have  investigated 
the  action  of  this  drug  are  the  least  inclined  to  use  it. 
If  medicines  are  tried,  there  are  others  much  safer  and 
more  efficient.  Oaulophyllm  has  in  several  instances 
brought  on  premature  labor  in  the  eighth  month ;  the 
same  is  asserted  of  Cimicifugin.  In  order  to  be 
effectual,  these  drugs  must  be  used  in  large  doses  — 
two  grains  of  the  former,  or  one  of  the  latter,  repeated 
every  hour  or  two. 

The  application  of  cupping  glasses  to  the  mammce, 
is  advised  by  Scanzoni.  Sucking-pumps  made  of  caout- 
chouc, were  applied  in  one  case  for  two  hours,  seven 
times  during  three  days.  After  the  third  application 


276  HALE   ON   ABORTION. 

the  cervix  uteri  wag  shortened ;  after  the  sixth  severe 
labor  pains  came  on,  and  after  the  seventh  the  child 
was  born.* 

Separation  of  the  membranes  by  the  introduction  of  at- 
\  Jieric  air,  or  gas,  has,  I  believe,  been  recommended 
for  the  purpose  of  inducing  premature  labor.  I  cannot 
recommend  this  plan,  as  I  believe  it  to  be  decidedly 
unsafe,  and  the  most  dangerous  of  all  methods,  not 
excepting  the  stiletted  canula.  Dr.  Hitchcockf  reports 
a  case  which  shows  conclusively  that  by  this  method 
air  may  be  forced  into  the  uterine  sinuses  and  cause 
death  by  entering  the  circulation. 

The  case  occurred  in  Kalaniazoo  county,  Michigan, 
and  happened  during  an  attempt  to  cause  abortion. 
u  The  operator,  through  an  instrument  introduced  into 
the  womb,  or  at  least  into  the  vagina,  blew  air  with 
his  mouth,  when  immediately  the  woman  screamed, 
struck  at  the  operator,  fainted,  and  was  found  a  minute 
or  two  afterwards  blue  in  the  face  and  insensible,  the 
muscles  about  the  arms  and  neck  having  a  trembling 
motion."  The  case  presented  an  entire  correspondence 
with  the  symptoms  described  as  occurring  in  cases 
where  death  is  known  to  have  occurred  from  the  acci- 
dental entrance  of  air  into  the  circulation  during  sur-. 
gical  operations.  The  post-mortem  appearances  observed 
were  also  altogether  consistent  with  the  theory  of  death 
from  the  introduction  of  air  into  the  circulation ;  namely, 
extreme  congestion  of  the  lungs,  entire  absence  of  blood 
from  the  left,  and  nearly  so  from  the  right  cavities  of 
the  heart ;  the  escape  of  air  from  the  uterus  the  instant 
its  walls  were  incised ;  the  marble  whiteness  of  the  ex- 
tremities, and  the  unusual  paleness  of  the  brain  and  its 
membranes. 

*  Braithwaite,  Part  XXVIII.,  page  263. 
f  Trans.  Amer.  Med.  Association,  1865. 


OBSTETRIC   ABORTION.  277 

Galvanism.  —  The  employment  of  galvanism  or 
electro-magnetism  was  first  suggested  by  Huder  in  1803, 
for  the  purpose  of  bringing  on  uterine  contractions, 
after  all  other  means  failed.  This  is  accomplished  by 
placing  one  pole  of  the  battery  on  either  side  of  the 
uterus,  continuing  the  application  of  the  current  for 
half  an  hour  or  an  hour  each  time,  and  renewing  it 
once  or  twice  daily ;  the  ordinary  magneto-electric 
apparatus  in  use  is  the  best  form,  as  repeated  shocks 
prove  more  effectual  and  certain  in  stimulating  the 
uterus  to  contractions  than  a  continued  current.  In 
applying  the  poles,  it  wall  be  proper  to  attach  to  the 
discs  a  sponge  moistened  with  water,  or  salt  and  water, 
or  pieces  of  thin  flannel  likewise  moistened  may  be 
placed  between  the  discs  and  the  abdomen.  Some 
apply  one  pole  to  the  neck  of  the  uterus,  and  the  other 
to  the  spine  or  abdomen  immediately  above  the  fundus. 

Dr.  Radford  says  that  "  galvanism  not  only  originates 
the  temporary  contractions  of  the  uterus,  but  also  pro- 
duces such  a  lasting  impression  on  that  organ  that  pains 
continue  to  occur  until  the  labor  is  terminated.  It 
produces  severe  pains  in  the  loins,  and  great  bearing 
down  efforts,  followed  by  dilation  of  the  os,  and  expul- 
sive pains. 

Dr.  King  says,  "  I  have  employed  this  agent  in  a  few 
cases,  and  with  invariable  success,  though  the  number 
and  intensity  of  the  applications  had  necessarily  to  be 
varied  in  each." 

In  cases  of  premature  labor,  the  foetus  does  not 
appear  to  be  injured  by  the  application  of  galvanism. 
Cases  of  still-birth  seldom  occur  from  its  use,  while  in 
the  majority  of  cases  where  ergot  is  used  the  child  is 
born  dead. 

Dr.  Kadford  writes,  "  Galvanism  is  especially  ad  van- 


278  HALE   ON   ABORTION. 

tageous  as  a  general  stimulant  in  all  those  cases  in 
which  the  vital  powers  are  extremely  depressed  from 
loss  of  blood.  Its  beneficial  effects  are  to  be  observed 
in  the  change  of  countenance,  restoring  an  animated 
expression  ;  in  its  influence  on  the  heart  and  arteries  ; 
in  changing  the  character  of  respiration  ;  and  its  warm- 
ing influence  upon  the  general  surface.  I  have  several 
times  Observed,  in  cases  in  which  other  powerful  stim- 
ulants have  failed  to  produce  any  beneficial  results,  the 
most  decided  advantages  accrue  from  its  application." 

This  recommendation  would  lead  us  to  use  this  agent 
in  the  prostration  and  chill  which  sometimes  ushers  in 
an  abortion.  In  such  cases  the  abortion  is  inevitable  ; 
and  galvanism  would  be  productive  of  great  benefit 
both  by  bringing  on  healthy  reaction  and  aiding  the 
uterus  in  expelling  its  contents. 

Galvanism  will  cause  embryonic  and  foetal  abortion, 
as  well  as  premature  labor.  I  have  made  use  of  it  in 
several  cases.  In  one  it  caused  an  easy  abortion  in  the 
fourth  month  (this  was  a  case  of  dangerous  vomiting)  ; 
in  another  it  acted  satisfactorily  in  the  eighth  week  of 
pregnancy.  In  a  case  where  it  was  decided  necessary 
to  terminate  the  pregnancy,  it  was  used  but  on.ce,  and 
for  five  minutes  only.  Pains  immediately  set  in,  accom- 
panied by  some  haemorrhage.  The  abortion  would 
undoubtedly  have  proceeded  to  a  termination,  had  not 
the  woman,  under  the  idea  of  hastening  the  labor,  drank 
a  "  hot  gin  sling."  Strange  to  say,  this  stimulant  im- 
mediately arrested  the  abortivant  process,  the  pain  and 
haemorrhage  ceased,  and  did  not  return.  (Was  it  by 
virtue  of  the  juniper  (salina)  contained  in  it  ? )  Four 
weeks  were  suffered  to  elapse,  when  the  abortion  was 
brought  on  by  the  use  of  the  catheter. 

Dr.  Robert  Barnes,  Lecturer  on  Midwifery  to  the 


OBSTETRIC    ABORTION.  2*9 

Royal  Free  Hospital  Medical  College,  England,  once 
wrote  a  paper  on  the  Use  of  Galvanism  in  Obstetrics. 
It  is  worthy  of  attentive  perusal,  as  it  enters  fully  into 
a  consideration  of  the  action  of  this  a^ent. 

O 

The  article  was  published  in  Braithwaite's  Retro- 
spect, Part  xxix.,  pages  259 — 268,  and  is  copied  by  Dr. 
King,  in  his  Obstetrics,  pages  669 — 681. 


SECTION    II. 

FCETAL     ABORTION. 

Postal  abortion  consists  in  the  expulsion  of  the  pro- 
duct of  conception  during  the  second  stage  of  pregnancy, 
viz.,  from"  the  date  of  the  connection  of  the  placenta 
with  the  uterus,  to  the  date  of  viability  of  the  child. 

The  induction  of  abortion  during  this  stage  may  be 
resorted  to  for  the  same  reasons  given  above,  where  it 
is  not  deemed  pnident  to  wait  until  the  child  is  viable. 
The  same  obstructions,  existing  to  a  greater  degree, 
will  make  it  proper  to  cause  the  expulsion  of  the  fcetus 
before  the  seventh  month.  In  these  cases,  the  life  of 
the  mother  is  to  be  considered  beyond  all  other  con- 
siderations. 

The  same  means  may  be  used,  and  will  be  found 
equally  efficient  as  those  adopted  during  the  last  three 
months  of  pregnancy.  The  same  precautions,  having 
in  view  the  non-injury  to  the  placental  vessels,  are  to 
be  adopted,  because  it  is  better  to  have  the  placenta 
detached  by  the  contractions  of  the  uterus,  than  by  any 
instrument.  By  so  doing  much  hEemorrhage  is  avoided, 
which  might  become  dangerous  before  the  uterus  could 


HALE    OX    ABORTION. 

iade  to  expel  the  secundines.  As  before  noticed, 
the  haemorrhage  before  the  sixth  month,  generally 
occurs  before  the  expulsion  of  the  placenta,  whereas,  in 
premature  labor,  it  is  afterward*. 

For  the  safe  and  speedy  induction  of  foetal  abortion, 
I  ]  nvfer,  as  mentioned  under  premature  labor,  the  use 
of  the  flexible  bougie  or  catJieter,  or  the  injection  of  bland 
fluids  /"•/'/•<  tn  the  membranes  and  the  uterus.  A  com- 
bination of  the  two  operations  is  probably  the  best 
that  can  be  adopted.  My  favorite  method  is  to  intro- 
duce a  smooth  flexible  catheter  or  bougie  (having  one 
or  two  orifices  in  the  sides  of  its  extremity)  by  means 
of  a  wire  stiff  enough  to  act  as  a  conductor.  It  should 
be  introduced  carefully,  so  as  to  gently  insinuate  it 
between  the  membranes  and  the  uterus.  I  especially 
recommend  the  operator  not  to  puncture  the  mem- 
branes, for  according  to  all  experience,  this  accident 
should  be  avoided  during  the  whole  period  of  preg- 
nancy. When  the  instrument  has  been  carried  up 
nearly  to  the  fundus  of  the  uterus,  on  its  posterior 
surface,  the  wire  is  withdrawn,  and  one  or  two  ounces 
of  warm  milk,  glycerine,  olive  oil,  or  water,  is 
to  be  injected  by  means  of  any  syringe  which  will 
throw  a  continuous  stream.  The  modus  operand*  is 
plain.  The  fluid  permeates  between  the  membranes 
and  the  uterus,  separating  them  throughout  the  whole 


FLEXIBLE  BOUGIE  OR  CATHETER. 

or  a  large  portion  of  their  extent.     It  may  even  sepa- 
rate the  placenta  during  the  fourth  or  fifth  month.     At 


OBSTETRIC   ABORTION.  281 

the  same  time  the  presence  of  the  fluid  causes  uterine 
contractions  of  a  forcible  character,  which  generally 
ends  in  the  expulsion  of  the  fcetus  and  secundines,  with 
little  or  no  haemorrhage.  The  chitt,  or  rigor,  previ- 
ously mentioned  among  the  symptoms  of  abortion,  is  a 
sure  indication  that  the  operation  has  been  successful 
and  efficient. 

It  sometimes  happens  that  it  is  difficult,  and  even 
impossible,  to  inject  any  fluid  into  the  uterus  through 
the  catheter  or  bougie,  owing,  probably,  to  the  com- 
pression of  the  instrument  by  the  contraction  of  the 
cervix  uteri,  or  the  whole  organ.  To  avoid  this  diffi- 
culty, I  have  frequently  made  use  of  a  hard  rubber 
syringe,  holding  two  ounces,  and  having  a  tube  about 
eight  to  ten  inches  in  length,  and  about  one-fourth  or 
one-sixth  of  an  inch  in  diameter,  with  a  very  smoothly 
rounded  point.  (See  cut  on  page  275). 

The  only  instrument  of  this  character  now  sold,  has 
its  tube  straight.  But  before  it  can  be  used  for  the 
purpose  here  recommended,  it  must  be  bent  to  the 
requisite  curve.  The  extent  of  this  curve  will  depend 
on  the  position  and  size  of  the  uterus,  and  the  period 
of  pregnancy.  The  tact  and  judgment  of  the  phy- 
sician must  be  the  guide  in  this  matter.  To  prepare 
the  tube  so  that  it  can  be  bent  to  the  requisite  curve, 
it  is  only  necessary  to  plunge  it  into  boiling  water  for 
a  minute,  when  it  will  become  quite  ductile,  and  may 
be  made  to  assume  any  curve  desired. 

When  the  tube  has  been  introduced  into  the  uterus — 
as  directed  for  the  bougie — the  piston  is  to  be  slowly 
pushed  down,  so  as  to  force  the  fluid  gently  out,  and 
effect  a  gradual  separation  of  the  membranes. 

In  filling  the  syringe,  previous  to  its  introduction, 
care  should  be  taken  to  exclude  all  air,  as  the  presence 


282  .  HALE   ON   ABORTION. 

of  air  in  the  uterus  is  neither  safe  or  desirable.  The 
woman  should  remain  in  the  recumbent  position  for 
half  an  hour  or  more  after  the  operation,  or  until  the 
occurrence  of  the  rigors.  For  obvious  reasons,  the 
best  time  for  the  operation  is  in  the  evening  after  the 
patient  has  retired  for  the  night.  It  is  advisable  that 
the  bladder  and  rectum  be  emptied  of  their  contents ; 
the  latter  by  enema,  if  any  foecal  matter  has  accumu- 
lated there. 

It  is  taught  by  some  medical  writers  that  it  is  haz- 
ardous to  inject  fluids  into  the  uterus.  Whatever 
danger  there  may  be  in  the  uninipregnated  state  from 
fluids  passing  through  the  Fallopian  tubes  into  the 
peritoneal  cavity,  thereby  causing  inflammation,  this 
objection  is  not  valid  in  the  condition  under  consider- 
ation, for  during  pregnancy  those  tubes  are  undoubtedly 
plugged  up  with  tenacious  mucus,  which  would  effectu- 
ally prevent  the  passage  of  any  fluid. 

This  simple  and  effective  method  is  far  preferable  to 
puncturing  the  membranes,  which  nearly  always  results 
in  a  tedious  labor ;  or  the  douche,  which  is  altogether 
complicated  and  slow  of  operation ;  or  the  administra- 
tion of  drugs,  which  is  always  uncertain,  and  generally 
injurious.  No  other  method  yet  known  is  at  all  com- 
parable with  it,  and  in  my  opinion  none  other  should 
be  adopted  by  the  conscientious  physician  who  seeks 
in  all  cases  the  good  of  his  patient  above  all  else. 


OBSTETRIC   ABORTION.  283 

SECTION    III. 

EMBRYOOTC    ABORTION. 

The  induction  of  abortion  during  the  three  months 
following  conception,  is  sometimes  necessary  and  justir 
fiable.  If  the  pregnancy  is  not  to  be  allowed  to  go  on 
until  such  time  as  the  child  is  viable,  it  is  absurd  to 
wait  any  time  after  the  physician  has  decided  on  the 
necessity  of  the  operation,  as  every  day's  delay  renders 
it  more  liable  to  be  productive  of  injury  to  the  woman. 
The  following  question  was  put  to  Dr.  Hunter,  in  1768, 
by  "W.  Cooper,  and  was  shortly  after  decided  in  the 
affirmative  by  most  English  practitioners : 

"  When  a  woman,  three  or  four  months  pregnant, 
has  so  contracted  a  pelvis  as  to  preclude  all  hope  of 
a  possible  expulsion  or  extraction  of  a  viable  foetus, 
may  we  think  of  inducing  abortion  2" 

One  of  the  latest  obstetric  writers — Cazeaux — 
declares  the  accoucher  is  warranted  in  producing  abor- 
tion, whenever  a  woman  who  is  five  or  six  months 
pregnant,  at  most,  shall  have  less  than  two  and  a  half 
inches  in  the  smallest  diameter  of  the  pelvis.  I  can 
not  see  the  propriety  of  waiting  until  the  woman  is  so 
far  advanced.  If  the  physician  is  cognizant  of  the 
pelvic  deformity,  and  also  of  the  -cominencement  of 
pregnancy,  he  should  induce  the  abortion  at  the 
earliest  possible  moment  consistent  with  the  patient's 
state  of  health.  He  should,  of  course,  be  sure  the 
woman  is  pregnant,  before  any  operation  is  performed ; 
but  it  is  my  opinion  that  he  had  better  err  in  this 
respect,  than  allow  a  pregnancy  to  go  on  till  a  late 


HALE   ON   ABORTION. 

date.  For  the  introduction  of  the  sound  or  bougie,  or 
the  injection,  of  fluids,  if  carefully  done  is  not  produc- 
tive of  injury,  and  may  even  bring  back  the  menses,  if 
that  was  the  only  obstruction.  The  .indications  for 
producing  an  abortion  during  the  first  third  of  preg- 
nancy, may  be  thus  summed  up :  Extreme  contraction 
of  the  pelvis;  voluminous,  immoveable,  and  non- 
operable  tumors  of  the  excavation ;  extreme  dropsy  of 
the  amnion;  irreducible  displacements  of  the  womb; 
haemorrhages  which  have  resisted  the  employment  of 
the  most  rational  measures ;  eclampsia,  mania,  chorea, 
and  obstinate,  dangerous  vomiting. 

If  any  of  these  indications  obtain,  the  sooner  after 
conception  the  embryo  is  destroyed,  the  better  for  the 
health  and  safety  of  the  patient. 

Method  of  Operating. — Nearly  all  the  methods  men- 
tioned above,  except  the  injection  of  fluids,  are  inoper- 
ative when  used  during  the  first  stage  of  gestation. 
They  may  induce  the  abortion,  but  only  after  a  tedious 
trial,  and  nearly  always  to  the  injury  of  the  uterus.  I 
allude  to  the  sponge-tent,  ergot,  douche,  puncture  of  the 
membrane,  electricity,  and  colpeurysis. 

The  most  efficient  methods  are :  (1)  The  introduction 
of  the  bougie.  (2)  The  injection  of  fluids.  (3)  The 
forceps.  (4)  The  uterine  sound. 

The  bougie  or  flex'Me  catheter  is  an  effective  instru- 
ment for  terminating  pregnancy  before  the  end  of  the 
third  month.  If  introduced  into  the  uterus  without 
rupturing  the  membranes,  it  will  bring  on  labor  with 
expulsion  of  the  ovum  entire,  with  the  decidua.  Before 
the  fourth  month,  so  close  is  that  tissue  to  the  uterus, 
that  it  is  a  matter  of  doubt  whether  a  bougie  or  any 
other  instrument  can  be  insinuated  between  the  two 
adherent  surfaces.  The  instrument  must  then  pass 


OBSTETRIC  ABORTION.  285 

through  the  orifice  at  the  cervix,  and  between  the 
membranes  of  the  ovum  and  the  decidua.  It  is  best 
not  to  use  sufficient  force  to  rupture  the  delicate  mem- 
branes of  the  ovum,  so  delicate  that  I  imagine  they  are 
destroyed  in  a  large  majority  of  the  cases  where  instru- 
ments are  used  in  the  early  months,  especially  during 
the  first  eight  weeks. 

To  use  the  bougie  successfully,  select  a  smooth  one, 
about  one  quarter  of  an  inch  in  diameter,  with  a  curved 
wire  of  sufficient  size  to  render  it  a  good  conductor  (the 
wires  generally  found  in  bougies  and  catheters  are  too 
small  for  this  purpose.)  Have  the  woman  lie  on  her 
back,  near  the  side  of  the  bed,  with  the  knees  drawn 
up  and  the  hips  slightly  elevated.  First  ascertain  by 
the  touch  the  position  of  the  os  uteri,  its  condition,  etc. 
Moisten  the  instrument  with  oil  or  glycerine,  and  pass 
its  point  along  the  palmar  surface  of  the  index  finger 
of  the  right  hand,  the  end  of  which  should  rest  upon 
the  lower  lip  of  the  os  uteri.  Insinuate  the  instrument 
into  the  cervix,  and  push  it  gently  upward  towards  the 
uterine  cavity  until  it  meets  with  some  obstruction. 
These  obstructions  are  generally  the  lacunae  or  folds  of 
the  mucous  lining  of  the  neck.  Care  should  be  taken 
not  to  lacerate  these  folds  by  any  forcible  measures,  as 
such  injuries  lead  to  chronic  inflammations  of  the  cer- 
vical canal.  By  the  use  of  tact,  patience,  and  gentle 
efforts,  the  instrument  will  after  a  time  pass  suddenly 
into  the  uterine  cavity.  In  some  cases  of  primapara, 
the  introduction  of  any  instrument  through  the  cervical 
canal  is  a  matter  of  much  difficulty.  The  most  careful 
physician  and  practical  amateur  may  fail  after  efforts 
lasting  a  quarter  of  an  hour.  Sometimes  when  we  are 
about  to  give  up  our  efforts,  the  bougie  will  glide  into 
the  cavity  with  the  utmost  ease  and  readiness.  Any 


286  HALE   ON   ABORTION. 

one  who  will  take  the  trouble  to  examine  the  minute 
anatomy  of  the  cervical  canal,  and  note  the  small  size  of 
the  inner  orifice  of  the  canal,  and  the  numerous  lacunae 
or  crypts  of  the  enlarged  middle  portion,  will  under- 
stand the  reason  of  the  difficulty. 

When  the  bougie  shall  have  entered  the  cavity  of  the 
uterus,  it  should  be  slowly  pushed  upwards  until  it 
seems  to  meet  with  an  obstruction  to  its  funther  pro- 
gress. Here  all  efforts  to  introduce  it  further  should 
cease,  else  we  may  rupture  the  membranes  of  the  ovum. 
Now,  with  the  finger  and  thumb  of  the  right  hand, 
hold  the  bougie  firmly  in  its  place,  and  with  the  other 
hand  slowly  withdraw  the  wire,  not  directly  down- 
wards, but  with  a  circular  movement,  outward  and 
upward,  so  that  the  cwve  of  the  wire  will  follow  the 
axis  of  the  pelvis.  By  so  doing  we  avoid  any  unneces- 
sary irritation  of  the  interior  of  the  uterus,  or  a  rupture 
of  the  membranes. 

After  the  wire  has  been  withdrawn,  coil  the  end  of 
the  bougie  until  it  can  be  placed  in  the  vagina,  resting 
on  the  perineum,  or  if  it  is  not  flexible  enough  to  be 
easily  coiled,  the  protruding  end  may  be  cut  off.  At 
any  rate,  leave  the  instrument  in  the  womb,  until 
hemorrhage  or  labor  pains  set  in,  when  it  may  be 
removed.  To  keep  it  in  situ  until  such  an  occasion,  no 
aid  is  needed  if  the  woman  remains  in  bed  ;  but  if  she 
is  to  sit  up  or  walk,  a  bandage  should  be  worn. 

The  time  which  intervenes  between  the  introduction 
of  the  instrument  (if  it  be  retained)  and  the  occurrence 
of  pains,  etc.,  varies  from  six  to  twenty-four  hours, 
rarely  exceeding  the  latter.  It  is  very  rare  that  haemor- 
rhage occurs  during  a  foetal  abortion  caused  by  the 
proper  use  of  the  bougie. 

I  do  not  approve  of  the  plan  adopted  by  some  obste- 


OBSTETEIC   ABOKTION.  287 

tricians,  of  rotating  the  bougie  when  in  the  womb, 
and  then  withdrawing  it.  Not  only  is  injury  done 
thereby,  but  the  induction  of  abortion  by  such  a  method 
is  very  uncertain.  This  leads  us  to  the  considera- 
tion of 

The  Uterine  Sound.  Professor  Simpson  makes  use 
of  this  instrument  for  the  induction  of  abortion  in  the 
early  months  of  pregnancy.  The  silver  male  catheter 
has  been  substituted  for  it  in  some  instances.  Professor 
Simpson  directs  that  after  its  introduction  it  is  to  be 
turned  three  or  four  times  round,  and  then  withdrawn. 
That  this  method  will  prove  effectual  in  a  majority  of 
cases,  I  do  not  doubt ;  in  fact,  my  observations  lead 
me  to  believe  it  will  generally  destroy  the  embryo.  But 
Simpson  admits  that  the  operation  is  not  always  imme- 
diately effectual,  and  states  that  he  has  been  obliged  to 
repeat  it  several  times  in  some  cases,  before  the  uterus 
would  take  on  expulsive  action,  or  before  he  was  satis- 
fied the  embryo  was  destroyed.  There  are  many  other 
objections  to  the  use  of  the  sound,  especially  in  the 
third  month  of  gestation.  If  not  used  with  great  care, 
the  interior  of  the  uterus  will  be  abraded  or  other- 
wise injured  by  its  forcible  rotation.  Next  to  the 
bougie,  however,  it  is  the  best  and  most  certain  method 
of  causing  abortion  now  known.  Its  introduction  is 
effected  in  the  same  manner  as  that  of  the  bougie. 


UTERINE    SOUND. 


HALE   ON   ABORTION. 

The  injection  of  fluids,  &s  described  under  Premature 
L<il'<>i\  may  be  resorted  to  when  the  above  means  are 
not  at  hand,  or  when  it  is  deemed  advisable  not  to  use 
them.  The  introduction  of  the  curved  tube  should  be 
conducted  as  described  above.  Not  more  than  one 
ounce  of  liquid  should  be  injected  at  once.  When  the 
syringe  is  used,  a  sensation  of  faintness,  or  actual  syn- 
cope sometimes  occurs  immediately  after  the  operation. 
The  ri^ or  occurs  sooner  than  when  other  instruments 

o 

are  used. 

The  Forceps. — This  instrument  is  similar  to  a  variety 
of  "bullet  forceps,"  used  in  military  surgery  for  the  seizure 
and  extraction  of  foreign  substances  in  the  tissues.  It 
consists  of  four  "  claws,"  which  are  sheathed  in  a  tube 
during  its  introduction,  and  are  made  to  protrude  and 
open  when  in  the  interior  of  the  uterus.  The  instru- 
ment is  pushed  upward  to  the  fundus  uteri,  to  the  posi- 
tion the  ovum  is  supposed  to  occupy,  when  the  "claws" 
are  closed  upon  the  embryo,  if  reached,  and  the  whole 
forcibly  extracted.  This  instrument  is  the  one  most 
generally  employed  by  those  villains  who  disgrace  the 
medical  profession  and  humanity  by  practising  the  vile 
trade  of  producing  criminal  abortion.  The  instrument 
may,  however,  be  used  by  the  honorable  physician  for 
legitimate  purposes.  It  may  be  used  when  the  other 
instruments  mentioned  are  not  obtainable,  or  proper ; 
or  for  the  purpose  of  removing  a  retained  placenta  or 
membranes,  or  any  residual  mass. 


ABORTION   FORCEPS. 


OBSTETRIC    ABOETION.  289 

Various  other  instruments  have  been  used  by  physi- 
cians and  abortionists.  The  stiletted  catheter  was  once 
in  general  use.  There  are  several  varieties  of  this  in- 
strument, but  all  upon  the  general  plan  of  a  sheathed 
needle  or  lancet,  which  can  be  protruded  when  intro- 
duced into  the  uterus,  and  having  for  their  aim  the 
rupture  of  the  membrane  of  the  ovum. 

Besides  the  mechanical  measures  above  enumerated, 
for  the  purpose  of  inducing  abortion  in  the  first  stage 
of  pregnancy,  the  medicinal  means  may  not  pass  unno- 
ticed. When  premature  labor  or  foetal  abortion  is 
induced  by  medicines,  they  set  up  uterine  contractions, 
and  thereby  dislodge  and  expel  the  uterine  contents. 
But  owing  to  the  non-development  of  the  muscular 
tissue  of  the  womb  in  the  earlier  months,  such  effectual 
contractions  can  rarely,  if  ever,  be  aroused.  Medicines, 
therefore,  which  cause  abortion  during  the  first  three 
months,  must  cause  it  by  simulating  the  menstrual 
process — namely,  uterine  congestion  and  haemorrhage, 
with  the  exfoliation  of  the  decidua. 

Now,  nearly  all  the  medicines  mentioned  under 
"  Medicinal  Causes  of  Abortion,"  are  capable,  under 
certain  circumstances,  of  causing  so  much  congestion, 
as  to  set  up  a  pseudo-menstrual  nidus,  and  the  conse- 
quent arrest  of  gestation.  If,  however,  the  uterus  is  in 
a  healthy  condition,  I  do  not  think  such  medicines, 
unless  taken  in  massive  and  dangerous  doses,  are  ever 
capable  of  such  effects  ;  but  when  the  uterus  is  diseased, 
and  has  been  "  irritable,"  then  almost  any  one  of  them, 
if  administered  at  or  near  the  usual  menstrual  periods, 
will  be  very  apt  to  cause  such  ainux  of  blood  as  to  lead 
to  the  destruction  of  the  product  of  conception. 
19 


•_",»<>  HALE    ON    ABORTION. 


SECTION   IV. 

OVULAR    ABORTION. 

Another  variety  of  abortion  might  be  considered 
under  the  title  of  Ovular. 

This  might  be  defined  as  the  destruction  of  the  ovum 
at  any  time  after  it  leaves  the  Graafian  vesicle,  and  be- 
fore it  has  been  impregnated  by  the  seminal  fluid. 

In  other  words,  any  measures  which  are  adopted  to 
prevent  the  impregnation  of  the  ovum,  must  result  in 
ite  destruction. 

If,  from  good  and  sufficient  causes,  it  is  considered 
best  that  the  fruit  of  conception  should  not  be  allowed 
to  go  on  to  the  end  of  utero-gestation,  would  it  not  be 
better,  in  a  medico-legal,  as  well  as  in  a  moral  point  of 
view,  to  arrest  or  prevent  conception  itself  ? 

If  premature  labor  is  to  be  avoided  in  all  cases,  and 
only  resorted  to  to  save  the  life  of  the  mother  or  child, 
or  both ;  if  it  is  preferable  to  allow  the  mother  to 
run  the  risk  of  her  life,  and  suffer  from  dangerous  dis- 
eases ;  if  fcetal  and  embryonic  abortion  is  only  to  be 
resorted  to  in  the  most  dangerous  cases,  and  avoided 
because  morally  and  legally  it  is  a  crime,  equal  to,  if 
not  identical  with,  murder ;  if  so  many  grave  obstacles 
are  in  the  way,  inducing  us  to  avoid  any  of  these  opera- 
tions,— would  it  not  be  better,  in  all  cases,  for  the  phy- 
sician to  advise  that  ovular  abwtion  be  allowed  ?  By 
adopting  this  plan  to  prevent  the  occurrence  of  gesta- 
tion, no  crime  is  committed,  and  there  is  no  risk  of 
human  life.  I  admit  that  this  is  not  feasible  in  a  large 


OVULAR    ABORTION.  291 

proportion  of  the  cases.  Physicians  are  rarely  consulted 
until  after  pregnancy  is  well  advanced,  and  often  not 
until  the  period  of  confinement  itself.  But  after  the 
physician  has  attended  one  confinement  where  the  life 
of  the  child  had  to  be  sacrificed  to  save  the  mother,  it 
is  his  duty  to  inform  his  patient  of  the  danger  of  a 
future  pregnancy,  and  advise  and  instruct  her  as  to  the 
best  possible  manner  of  preventing  the  occurrence  of 
that  state. 

All  perfect  theories  are  probably  Utopian.  A  theory 
which  should  regulate  and  define  the  laws  which  relate 
to  marriage  is  so  Utopian  that  it  may  never  be  real- 
ized. If  it  were  possible  to  regulate  this  matter  by 
absolute  law,  the  following  rules  would  have  to  be  car- 
ried into  effect : 

(a)  No  woman  should  marry  until  it  was  decided 
by  a  competent  physician  that  no  physical  deformity 
existed  which  would  incapacitate  her  from  bearing  a 
living,  average  sized  child,  at  full  time. 

(b)  After  a  woman  has  had  one  labor,  attended 
with  great  danger  to  herself,  and  involving  the  death 
of  the  child,  it  should  be  rendered  obligatory  upon  the 
parents  to  prevent  the  occurrence  of  future  conceptions. 

If  these  two  rules  were  adopted  by  all  civilized 
nations,  it  would  narrow  down  the  necessity  for  the 
induction  of  Abortion  to  a  very  small  number  of  cases 
of  difficult  and  dangerous  labor. 

Even  in  the  present  condition  of  society,  much  might 
be  done  if  physicians  would  do  their  duty,  and  they 
were  upheld  by  public  opinion  and  public  confidence. 
The  fault  is  both  with  the  physician  and  people.  Phy- 
sicians are  not  honest  and  frank  enough  with  their 
patients  :  they  do  not  give  them  the  proper  advice  and 
instruction  in  the  premises.  We  read  of  women  pass- 


•J'.i2  HALE    ON   ABORTION. 

ing  through  a  succession  of  pregnancies,  ending  in  each 
case  with  craniotomy  or  Caesarian  section,  and  every  time 
under  the  care  of  the  same  family  physician  !  Did  the 
physician  do  his  duty  in  these  cases  ?  Did  he  instruct 
the  parents  how  to  prevent  a  conception  which  was 
fraught  with  such  dangerous  results?  Why  do  not 
family  physicians  protest  against  allowing  young 
women  to  marry,  whom  they  know,  or  believe,  are  not 
in  normal  physical  condition  to  bear  children  ?  The 
people  are,  perhaps,  more  to  blame  than  physicians,  in 
this  matter.  This  arises  from  the  general  ignorance 
which  prevails  on  all  subjects  pertaining  to  the  physi- 
ology of  generation.  This  ignorance  is  almost  absolute, 
for  not  one  layman  in  a  thousand,  even  if  he  is  other- 
wise well-read  and  intelligent,  has  a  correct  knowledge 
of  this  function.  In  fact,  the  most  ridiculous  and 
absurd  notions  are  held  by  the  people,  and,  I  regret  to 
say,  by  many  physicians,  in  relation  to  the  passage  of 
the  ovum,  the  manner  of  its  impregnation,  and  the 
nature  of  the  seminal  fluid. 

Books  which  teach  the  latest  discovered  facts  relat- 
ing to  generation  are  kept  out  of  the  hands  of  the 
young,  and  virtually  out  of  the  hands  of  the  public,  by 
the  very  nature  of  the  technical  language  in  which  they 
Are  written.  Every  man  and  woman,  before  entering 
into  marriage,  should  be  conversant,  in  some  way  or 
other,  with  all  the  positive  facts  concerning  the  genera- 
tive process. 

That  I  may  not  be  blamed  for  asserting  that  physi- 
cians, even,  are  ignorant  of  facts,  I  will  quote  from  a 
work  by  a  distinguished  author,  who  is  considered  an 
authority  by  the  profession.  Speaking  of  impotency, 
he  says : 


OVULAR   ABORTION.  293 

"  Eacjulation  is  weak  and  precipitate,  so  that  the 
seminal  fluid  cannot  be  thrown  into  the  cavity  of  the 
uterus  *  *  it  is  not  sufficient,  in  order  to  fecundate, 
simply  to  spread  the  fluid  Over  the  vagina  :  it  must  be 
projected  with  sufficient  force  through  the  orifice  of  the 
uterine  neck."* 

This  assertion  is  at  variance  with  all  the  well-known 
facts  relating  to  impregnation.  A  fraction  of  a  drop 
of  the  seminal  fluid  upon  the  vaginal  mucous  membrane 
is  sufficient  to  result  in  impregnation,  if  the  proper  time 
is  selected  for  the  experiment.  Not  only  is  the 
author's  knowledge  of  physiology  deficient,  but  his  ana- 
tomical knowledge  is  in  a  worse  condition.  The  uter- 

O 

ine  neck  is  scarcely  ever  sufficiently  open  to  permit  of 
the  seminal  fluid  being  thrown  in  by  ejaculation.  It 
does  not  open  during  coition,  and  need  not  be  open  in 
the  manner  implied  by  Lallemand.  It  may  be,  and  is 
generally,  closed,  but  not  impervious.  Nothing  short 
of  actual  occlusion  can  prevent  the  spermatozoa  from 
insinuating  themselves  into  the  uterine  cavity.  The 
majority  of  the  people  entertain  an  idea  similar  to  Lal- 
lemand's,  and  think  they  take  due  precaution,  when  in 
fact  no  real  precaution  is  taken  to  prevent  impregnation. 

Ovular  Abortion,  may  be  allowed  by  adopting  certain 
regulations  concerning  the  act  of  coition. 

First,  by  regulating  the  time  of  its  occurrence. — In  all 
except  about  six  per  cent,  of  cases,  according  to  M. 
Rociborski,  coition  will  not  result  in  impregnation,  if 
not  performed  until  ten  days  after  the  cessation  of  the 
menses,  nor  within  four  days  previous  to,  or  during 
their  occurrence.  Coitus  immediately  after  or  during 
menstruation,  has  often  been  advised  as  a  cure  for  ster- 
ility, and  frequently  with  success.  Among  the  Jews, 

*  Lallemand  on  Spermatorrhoea. 


294  HALE    ON   ABOKTION. 

women  are  not  allowed  sexual  intercourse  until  twelve 
days  after  menstruation  ;  yet  the  women  of  that  race 
are  noted  for  their  fertility.  This  is  accounted  for  on 
the  supposition  that  impregnation  took  place  just  pre- 
vious to  menstruation.  When  conception  occurs  at  this 
time,  the  catamenia  sometimes  appear,  and  are  some- 
times absent ;  if  they  appear  their  duration  is  generally 

less  than  usual.* 

I  am  inclined  to  think  that  the  rates  of  six  or  seven 

per  cent,  are  too  small.  Some  women  will  conceive  at 
any  period  between  the  menses,  even  when  only  the 
slightest  particle  of  seminal  fluid  is  brought  in  contact 
with  the  vaginal  surface. 

The  rule  above  mentioned,  relating  to  the  avoidance 
of  coition  at  certain  times  cannot  be  considered  as  reli- 
able in  all  instances.  It  is  based  on  the  theory,  which 
in  the  majority  of  cases  seems  supported  by  facts,  that 
the  ovum  is  extruded  from  the  generative  passages  be- 
fore the  twelfth  day  after,  and  does  not  appear  therein 
before  the  fourth  day  previous  to  the  menstrual  period. 

When  the  experiment  has  been  tried,  and  found  to 
be  reliable,  the  rule  may  be  adopted  to  prevent  concep- 
tion, but  there  is  some  risk  in  trying  the  experiment. 

Some  women  are  in  the  habit,  acting  probably  under 
the  advice  of  physicians,  of  taking  some  powerful 
emmenagogue  just  previous  to  the  usual  menstrual 
period.  Such  drugs  may  act  in  two  ways  —  namely, 
by  causing  the  already  impregnated  ovum  to  be  ex- 
pelled with  the  unnatural  menstrual  flow,  or  increas- 
ing the  amount  and  force  of  a  natural  flow  (menorrha- 
gia)  which  will  wash  away  the  unimpregnated  ovum 
in  a  shorter  time  than  usual. 

Second,  by  regulating  the  manner  of  its  performance. — 

*  Carpenter,  Physiology,  page  361. 


OVULAR    ABOKTIOX.  295 

We  Lave  seen  that  under  certain  circumstances,  in  a 
large  proportion  of  cases,  Ovular  Abortion  will  occur  if 
coition  is  not  indulged  in. 

o 

We  will  now  consider  the  second  method  of  inducing 
ovular  abortion;  namely,  by  preventing  the  seminal 
fluid  from  coming  in  contact  with  the  ovum  in  the  geni- 
tal passage. 

This  can  only  be  done  by  placing  some  mechanical 
and  impervious  impediment  in  such  a  manner  as  will 
prevent  the  seminal  fluid  from  escaping  into  the  genital 
passages. 

As  the  ovum  must  be  impregnated  in  the  uterus,  Fal- 
lopian tubes,  or  ovaria,  if  any  obstacle  is  so  placed  as  to 
prevent  the  passage  of  the  spermatozoa  through  the 
neck  into  the  cavity  of  the  uterus,  impregnation  will 
not  take  place.  As  the  cervical  canal  cannot  be  closed 
by  any  mechanical  contrivance,  we  must  turn  to  other 
means  to  prevent  the  entrance  of  the  vivifying  animal- 
cules. 

Dr.  Casanova,  in  a  work  more  ingenious  than  reli- 

/  O 

able,*  gives,  in  a  chapter  on  the  "  Prophylaxis  of  Con- 
ception," the  following  as  a  preventive  of  impregnation : 
"  The  possibility  of  rendering  fecundity  ineffectual  by 
artificial  means,  is  founded  in  the  fact  that  if  an  appro- 
priate foreign  body  be  interposed  between  the  sexual 
organs  of  the  male  and  those  of  the  female,  sub  coitu, 
fecundation  will  not  take  place,  because  the  body  will 
stand  as  a  bar  or  impediment  to  the  absorption  of  the 
aura  spermatica  emitted  against  it  in  the  act  of  copu- 
lation." 

Dr.  Casanova  illustrates  this  phenomena  by  allusion 
to  the  discovery  of  Sir  H.  Davy,  that  a  wire-gauze 
lamp  prevents  the  flame  within  from  reaching  and 

*  Contributions  to  Physiology  and  Medical  Jurisprudence,  page  96. 


296  HALE    ON    ABORTION. 

exploding  the  explosive  gas  without.  He  goes  on  to 
say  that  if  a  small  piece  of  sponge,  or  any  analogous 
substance,  be  placed  within  the  vaginal  canal,  sub  coitu, 
it  will  produce  the  same  effect  as  the  wire-gauze  :  i.  e., 
it  will  represent  the  intermediary  agent  which  will 
interrupt  the  aura  seminalis  from  being  absorbed  from 
within,  thus  rendering  fecundation  impossible." 

Although  he  says,  "  I  have  tried  the  experiment 
therapeutically  more  than  once,  and  found  the  pheno- 
mena to  correspond,  and  to  be  in  perfect  harmony  with 
truth,"  we  are  obliged  to  deny  the  truth  of  his  theory, 
and  the  reliability  of  his  experiments.  There  are 
doubtless  cases  where  this  evidently  ineffectual  means 
would  prevent  impregnation,  for  there  are  cases  where 
even  the  slightest  precautions  are  sufficient.  In  refuta- 
tion of  his  assertion,  I  will  state  that  I  have  known  of 
many  instances  where  the  plan  he  describes  —  a  plan 
not  new  in  this  country — was  carefully  and  thoroughly 
tried,  and  in  not  one  of  these  instances  was  it  sufficiently 
effectual  to  be  reliable. 

The  reason  is  easily  explainable  by  the  fact  that 
only  an  infinitesimal  quantity  of  the  seminal  fluid  is 
requisite  for  the  purpose  of  impregnation.  When  we 
remember  that  the  mucous  membrane  of  the  vagina  is 
thrown  into  rugae  or  folds,  which  are  more  decided 
immediately  after  coition,  it  will  be  seen  that  a  consid- 
erable quantity  of  the  seminal  fluid  will  be  caught  in 
these  folds,  and  retained  there  after  the  sponge  has 
been  withdrawn,  for  it  is  impossible  for  a  sponge,  unless 
it  be  of  great  size  to  sweep  out  all  the  anirnalculse.  For 
this  reason  also,  all  those  contrivances  which  have  for 
their  object  the  removal  of  the  semen  with  a  sponge  or 
other  similar  material,  are  unreliable  in  most  cases. 

Dr.  Casanova  does  not  believe  that  impregnation  is 


OVULAR   ABORTION.  297 

caused  by  the  actual  contact  of  the  spermatozoa  with 
the  ovum,  but  by  the  absorption  of  what  he  terms  the 
"  aura  seminalis"  a  kind  of  imponderable  force.  Even 
if  this  were  true  —  and  the  theory  is  utterly  untenable 
—  it  would  be  so  much  the  worse  for  his  plan,  for  it 
is  evident  that  no  material  substance  of  a  porous  nature 
will  prevent  the  absorption  of  an  imponderable  aura. 

I  have  been  shown  an  india-rubber  ball  used  for  the 
purpose  of  preventing  impregnation.  It  was  directed 
to  introduce  it  into  the  vagina,  and  place  it  against  the 
os  uteri,  and  allow  it  to  remain  six  or  twelve  hours 
after  coition.  This  plan,  however,  afforded  no  protec- 
tion from  the  influence  of  the  semen,  for  conception 
took  place  in  spite  of  it,  and  for  very  obvious  reasons, 
namely  :  the  spermatozoa  will  live  several  days  in  the 
secretions  of  the  vagina.  Leewenhock  and  other  ob- 
servers have  discovered  them  in  a  living  condition  in 
the  uterus  and  Fallopian  tubes,  seven  and  eight  days 
after  connection.  Of  what  use,  then,  is  such  a  contriv- 
ance ?  I  have  known  conception  to  take  place  notwith- 
standing coitus  was  performed  wrhile  a  large  inflated 
rubber  pessary  was  in  the  vagina,  apparently  complete- 
ly filling  up  that  canal.  A  study  of  the  nature  of  the 
spermatozoa  will  convince  any  one  that  they  are  capa- 
ble of  insinuating  themselves  between  any  such  sub- 
stance and  the  vaginal  wall. 

There  is  but  one  contrivance  that  is  sufficiently  relia- 
ble to  be  mentioned  and  recommended,  and  one  which 
is  absolutely  reliable  so  long  as  it  remains  intact,  name- 
ly :  a  covering  made  to  be  worn  by  the  male,  of  sufficient 
size  to  cover  the  whole  of  the  penis.  It  should  be  made 
of  firm,  elastic  india-rubber,  or  good  gold-beater's  skin. 
The  first  named  material  is  to  be  preferred  when  a 
good  quality  is  used.  They  are  for  sale  under  the 


298  HALE    ON    ABORTION. 

name  of  "condom"  by  every  druggist,  and  in  all  phar- 
macies, and  the  trade  in  them  is  considered  legitimate. 
In  selecting  them,  care  must  be  taken  that  the  material 
is  firm,  and  contains  no  small  orifices,  and  will  resist  the 
pressure  of  the  air.  Some  will  easily  tear  when  air  is 
forced  into  them.  These  are  unfit  for  use,  as  are  those 
from  which  the  air  escapes  in  minute  quantities,  with  a 
very  low,  whistling  sound,  almost  imperceptible  to  the 
ear.  These  pin-holes,  as  they  may  be  called,  are  still 
large  enough  to  permit  the  passage  of  a  minute  quan- 
tity of  the  fluid  containing  spermatozoa.  After  each 
connection,  the  "  covering "  should  be  examined  care- 
fully, to  see  that  no  rent  nas  occurred  during  the  act, 
and  if  such  is  found  to  be  the  case,  injections  will  have 
to  be  used,  as  directed  below.  Some  of  these  "  cover- 
ings "  are  quite  durable,  and  if  proper  care  is  taken  of 
them,  by  cleaning,  keeping  them  dry  and  inflated,  and 
not  alloVing  them  to  become  adherent  to  the  box  where 
they  are  placed,  they  may  be  used  many  times,  and  re- 
main uninjured  and  impervious. 

When  it  is  known  that  spermatozoa  remain  in  the 
urethra  for  many  hours  after  coition,  or  until  free  urina- 
tion occurs,*  it  will  be  obvious  to  all  that  no  second 
entrance  of  the  penis  into  the  vagina  will  be  safe,  unless 
protected  by  the  covering,  or  after  urination  has  taken 
place.  Ignorance  of  the  fact  has  led  to  the  occurrence 
of  impregnation,  where  the  parties  were  very  much 
astonished  at  the  result. 

I  will  not  notice  at  any  length  the  plan  of  compress- 
ing the  urethra  so  as  to  prevent  the  semen  from  escap- 
ing during  the  orgasm,  and  until  the  withdrawal  has 
been  effected,  for  such  a  plan  would  be  productive  of 

*  Lallemand  on  Spermatorrhoea,  p.  262. 


OVULAR   ABORTION.  299 

the  most  serious  consequences,  and  result  in  organic  dis- 
ease of  the  male  organ  of  generation. 

I  hardly  need  allude  to  the  absurd  doctrine  taught 
by  Dr.  Casanova,  that  unless  the  woman  participates, 
or  enjoys  the  copulative  act,  conception  will  not  take 
place.  His  foolish  arguments  to  explain  away  the  facts 
which  disprove  this  theory,  are  unworthy  the  slightest 
notice  from  men  of  intelligence  and  science.  It  mat- 
ters not  what  the  condition  of  the  woman  is,  whether 
insensible,  indifferent,  or  absolutely  frigid,  if  the  ovum 
is  in  the  genital  passages,  and  the  semen  comes  in  con- 
tact with  it,  impregnation  will  take  place. 

We  now  come  to  the  third  and  last  method  of  caus- 
ing or  permitting  Ovular  Abortion,  namely :  the  des- 
truction of  the  spermatozoa. 

In  order  to  treat  this  subject  in  a  proper  manner,  we 
must  make  some  inquiries  into  the  nature  of  these  pecu- 
liar organisms,  upon  which  depend  the  fertilizing  qual- 
ities of  the  seminal  fluid. 

Notwithstanding  the  denial,  by  Casanova  and  a  few 
other  writers,  that  the  spermatozoa  are  independent  or- 
ganisms, or  veritable  animalcules,  it  is  needless,  in  the 
present  day,  to  enter  into  any  lengthy  refutation  of  the 
views  of  such  authorities. 

Dr.  Casanova  says  they  are  not  animalcules,  "  though 
they  possess  that  optical  illusion,  a  sort  of,  but  not  an 
independent  animal  life — that  is,  a  life  of  motion,  only, 
caused  by  the  effects  of  light."  (!)  Such  an  absurd  and 
incoherent  assertion  is  too  ridiculous  to  receive  serious 
notice,  and  would  not  be  noticed  at  all  in  this  place, 
were  it  not  that  it  is  desired  to  convey  to  the  reader  a 
truthful  idea  of  the  nature  and  importance  of  these  or- 
ganisms. I  am  aware  that  Dr.  Carpenter  writes  that 
the  spermatozoa  "  have  no  more  claim  to  a  distinct  ani- 


300  HALE   ON   ABORTION. 

inal  character  than  have  the  ciliated  epithelia  of  mu- 
cous membrane,  which  likewise  continue  in  movement 
when  separated  from  the  body.  They  appear  to  be 
nothing  else  than  cell-germs,  furnished  with  a  peculiar 
power  of  movement,  by  means  of  which  they  are  ena- 
bled to  make  their  way  into  the  situation  where  they 
may  be  received,  cheiished  and  developed."  These  as- 
sertions are  as  untenable  as  that  of  Dr.  Casanova.  I  will 
here  mention  a  few  facts  in  relation  to  the  nature  and 
qualities  of  the  spermatozoa,  sufficient  to  disprove  all 
the  above  statements. 

(a)  Leewenhock,  Gerber,  Valentin*,  Dujardin,  Wag- 
ner, and  other  eminent  microscopists,  all  testify  to  hav- 
ing discovered  traces  of  organization  in  spermatozoa. 
Commenting  on  this,  Hassall  properly  observes f  that 
"  the  determination  of  the  fact  that  the  spermatozoa  are 
possessed  of  even  the  smallest  amount  of  organization, 
would  involve  their  classification  in  the  animal  kingdom." 

(&)  The  motions  of  the  spermatozoa  are  proof  of 
their  animal  nature.  Hassall  says,  "  All  the  spermato- 
zoa contained  in  a  drop  of  semen  which  has  undergone 
dilution  will  not  start  into  motion  at  once ;  many  of 
them  will  remain  for  a  time  perfectly  motionless,  and 
then  suddenly,  as  it  were  by  an  act  of  volition,  begin  to 
move  themselves  in  all  directions."  Speaking  of  their 
"  mode  of  progression,"  the  same  writer  says, — "  The 
motions  of  the  spermatozoa  are  effected  principally  by 
means  of  the  tail,  which  is  moved  alternately  from  side 
to  side,  and  during  the  progression,  the  head  is  always 
in  advance."  It  is  stated  that  the  spermatozoa  of  differ- 
ent animals  move  in  a  different  manner,  because  they 
differ  very  much  in  their  form  and  structure.  This 

"  The  spermatozoa  of  the  bear  have  a  mouth,  anua  and  stomach,  or  a 
convoluted  intestine.    (Sec  illustration  in  Muller's  Embryology,  p.  1475). 
f  Microscopic  Anatomy,  vol.  1,  p.  225. 


OVULAE    ABOKTION.  301 

would  not  be  the  case  if  they  were  "nothing  more  than 
ciliated  epithelium." 

Hassall  also  states  that  "  in  the  varied  motions  exe- 
cuted by  the  spermatozoa,  they  exhibit  all  the  charac- 
ters of  volition  ;  thus  they  move  sometimes  quickly,  at 
others  slowly,  alter  their  course,  stop  altogether  for  a 
time,  and  again  resume  their  eccentric  movements. 
These  movements  it  is  impossible  to  explain  by  refer- 
ence to  any  hygroscopic  properties  which  may  be  inhe- 
rent in  the  spermatozoa,  they  appear  to  be  so  purely 
voluntary." 

Dr.  Morris  Wilson*  says  the  spermatozoa  when  mov- 
ing through  a  fluid,  "  turn  readily  out  of  the  way  of 
any  obstructions,  but  they  have  not  the  backward 
motion  of  vibriones."  (Would  ciliated  epithelium 
avoid  obstructions?) 

(c)  The  spermatozoa  are  influenced  by  the  poisons, 
or  chemical  agents,  in  the  same  manner  as  animal  organ- 
isms. While  they  "  retain  their  locomotive  powers  for 
a  very  long  time  in  fluids  of  a  bland  character — for  ex- 
ample, in  blood,  milk,  mucus  and  pus,  on  the  contrary, 
in  reagents  of  an  opposite  character,  and  in  those  pos- 
sessed of  poisonous  properties,  they  soon  cease  to  move ; 
thus  in  saliva  and  urine,  unless  these  fluids  be  very 
much  diluted,  their  motions  are  soon  destroyed,  and 
immediately  cease  in  the  acids  and  alkalies,  iodine, 
strychnine  and  the  watery  solution  of  opium."f  The 
narcotic  poisons  do  not  arrest  the  motions  of  ciliated 
epithelium. 

Lehman  J  says  "  the  motion  of  the  spermatozoa  is  de- 
stroyed by  the  solution  of  opium  and  strychnine ;  the 
tail  then  generally  remains  extended."  (Is  not  the  ani- 

*  "Diseases  of  the  Vesiculse  Seininales,"  in  Lalleraand's  Spermatorrhoea,  p.  346. 
f  Hassall's  Microscopic  Anatomy.  f  Physiological  Chemistry,  p.  70. 


302  HALE    ON    ABORTION. 

malcule  rendered  tetanic  by  the  poison?)  Hassall 
thinks,  the  result  of  the  application  of  these  poi- 
sons, furnishes  an  additional  argument  in  favor  of  the 
unimnlity  of  the  spermatozoa,  and  one  which  it  would 
be  difficult,  if  not  impossible,  satisfactorily  to  contro- 
vert. 

Dalton*  makes  the  bold  assertion  that  the  spermato- 
zoa cannot  properly  be  considered  as  animals.  He  says 
their  motions  are  "  precisely  analogous  "  to  that  of  cili- 
ated epithelium.  He  further  says  that  they  are  organic 
forms,  produced  in  the  testicles,  and  forming  a  part  of 
their  tissues,  just  as  the  eggs,  which  are  produced  in 
the  ovaries,  are  a  part  of  those  organs.  Draperf  says, 
"  it  has  never  yet  been  established  that  anything 
answering  to  a  true  structural  arrangement  exists,  and, 
upon  the  whole,  it  may  be  concluded  that  the  appear- 
ances which  have  been  by  some  supposed  to  indicate 
organization,  are,  in  reality,  only  an  optical  illusion." 

Notwithstanding  the  assertions  of  these  high  author- 
ities, we  must  remember  that  the  later  discoveries  with 
the  microscope  have  overturned  a  great  many  just  as 
bold  assertions  of  the  earlier  physiologists. 

It  will  be  more  in  accordance  with  true  scientific 
modes  of  thought,  not  to  assert  of  the  spermatozoa  a 
want  of  organization,  because  we  cannot  discover  and 
demonstrate  it,  but  to  await  the  results  of  more  minute 
investigations. 

Not  only  is  it  necessary  to  impregnation  that  the 
seminal  fluid  should  contain  these  animalcules,  but 
they  must  be  perfectly  organized,  and  alive. 

Wagner  found  that  in  the  semen  of  hybrids  the  sper- 
matozoa were  altogether  wanting,  or  occurred  in  small 
numbers,  and  were  ill-formed  and  ill-conditioned.  It  is 

*  Human  Physiology,  p.  542.  f  Human  Physiology,  p.  519. 


OVULAE    ABOETION.  303 

a  well-known  fact  that  hybrids  are  incapable  of  bear- 
ing offspring. 

In  men  suffering  from  impotence,  the  seminal  fluid  is 
found  destitute  of  spermatozoa,  or  if  present,  they  seem 
to  be  either  lifeless  or  of  feeble  vitality. 

It  is  generally  believed  that  the  introduction  of 
semen  into  the  uterus,  the  spermatozoa  of  which  were 
dead,  would  not  result  in  impregnation.  M.  M.  Pro- 
vost and  Dumas,  who  filtered  the  seminal  fluid,  found 
that  the  fluid  portion,  which  passed  through  the  filter, 
would  not  vivify  the  eggs  (of  a  frog),  while  the  more 
solid  part,  consisting  of  the  spermatozoa,  produced  im- 
pregnation. The  apparently  contradictory  experiment 
of  Spallanzini  does  not  controvert  this,  for  it  is  not  ab- 
solutely known  that  the  spermatozoa  of  frogs  die  in 
thirty-five  hours  after  being  placed  in  water  at  a  tem- 
perature of  seventeen  to  nineteen  degrees,  or  even  in 
fifty -five  hours  in  water  three  degrees  above  zero,  while 
it  is  known  that  the  spermatozoa  of  fishes  will  live  sev- 
eral days  and  retain  their  power  of  impregnation. 
Moreover,  in  all  cold-blooded  animals,  cold  does  not 
have  that  destructive  effect  that  it  does  on  the  warm- 
blooded. 

From  all  the  above,* it  is  evident  that  three  proposi- 
tions may  be  laid  down  : 

I.  That  impregnation  may  occur,  it  is  necessary  that 
the  semen  contain  living,  perfectly  organized  spermato- 
zoa, and  that  these  animalcules  must   come  in  contact 
with  the  ovum  while  in  the  living  condition. 

II.  That  any  agent  which  is  capable,  when  brought 
in  contact  with  the  ''spermatozoa,  of  destroying  their 
life,  will  prevent  their  power  of  impregnation. 

III.  That  if  they  are  wholly  washed  out  of  the 


304  HALE    ON   ABORTION. 

vagina  and  cervical  canal  immediately  after  coition, 
impregnation  cannot  take  place. 

It  follows,  therefore,  that  to  cause  Ovular  Abortion, 
by  other  than  rules  relating  to  the  time  of  the  act  of 
coition,  or  the  mechanical  prevention  of  the  contact  of 
the  spermatozoa  with  the  ovum,  the  results  of  the 
second  and  third  proposition  must  be  obtained. 

To  destroy  the  life  of  the  spermatozoa  while  in  the 
vagina,  some  substance  inimical  to  their  vitality  must 
be  thrown  into  that  passage  in  such  a  manner  as  to 
come  in  contact  with  them,  when  holding  the  seminal 
fluid  in  solution. 

We  must  first  ascertain  the  substances  which,  when 
thus  brought  in  contact  with  the  spermatozoa,  will 
destroy  their  vitality  and  power  of  impregnation. 

Among  the  most  prominent  of  these  agents  are,  cold 
water,  watery  solution  of  opium,  spirits  of  wine,  salts, 
acukj  alkalies,  astringents,  strychnine,  and  probably  all 
narcotics  and  other  poisons.  Gelseminum,  arnica,  aco- 
nite, and  other  medicines,  are  among  the  latter.  Has- 
sall  says  the  spermatozoa  are  devoid  of  life  in  persons 
who  have  died  from  the  poisonous  effects  of  prussic 
acid. 

Under  certain  conditions,  any  one  of  the  above  men- 
tioned agents  might  be  resorted  to  for  the  purpose  of 
causing  de  vital  ization  of  the  spermatozoa,  in  order  to 
insure  ovular  abortion. 

The  selection  of  the  agent  would  depend  on  the 
health  of  the  woman,  and  the  local  diseases  to  which 
she  was  subject.  The  physician  of  the  parties  should 
be  the  judge  of  this  matter. 

Cold  water  should  generally  have  the  preference  in 
the  majority  of  cases.  By  reference  to  a  previous  para- 
graph it  will  be  seen  that  cold  water  causes  motion 


OVULAR   ABORTION.  305 

to    cease  in  human  spermatozoa — rolls  them  up  and 
destroys  their  power  of  impregnating  the  ovum. 

Opium  would  hardly  be  admissible  except  under 
peculiar  circumstances.  The  Same  may  be  said  of 
spirits  of  wine  and  strychnine. 

The  latter,  however,  may  be  used  cautiously,  when 
there  is  great  relaxation  of  the  vaginal  muscles,  with 
prolapsus.  I  have  known  vaginal  injections  of  a  solution 
of  strychnine,  (one  grain  to  one  quart  of  water)  to  cure 
a  most  obstinate  case  of  chronic  prolapsus  from  atony 
of  the  muscular  tissues.  One  drachm  of  the  tincture  of 
nux  vomica  in  the  same  amount  of  water  has  been 
equally  effectual.  Either  preparation,  in  cold  water,  if 
injected  immediately  after  coition,  would  doubtless 
result  in  the  destruction  of  the  animalcules. 

A  solution  of  common  salt  is  quite  popular  as  an 
enema  for  the  prevention  of  conception.  It  is  used  at 
about  the  strength  of  ordinary  sea-water.  I  have  been 
informed  by  many  of  my  patients  who  have  used  this 
agent,  that  it  cured,  in  a  short  time,  a  profuse  and  long 
lasting  Ieucorrho3a,  and  was  quite  effectual  for  the  origi- 
nal purpose. 

The  acids,  even  when  used  quite  dilute,  have  the 
effect  of  destroying  the  motions  of  the  spermatozoa. 
Acetic  acid,  or  vinegar,  largely  diluted  with  water,  is 
used  to  a  considerable  extent.  Sulphuric  acid  has  been 
recommended,  and  cases  have  come  under  my  observa-  ... 
tion  where  this  was  habitually  resorted  to.  The  water 
used  as  an  enema  is  rendered  slightly  acid  by  it,  not 
sufficiently  so  to  cause  any  smarting  of  the  mucous 
surface.  A  very  popular  and  effectual  mixture  for 
vaginal  enema  is  made  of  sulphuric  acid  and  alum* 

*  5  Acid.  Sulph.  dil.  3j- 
Aluinen,  3j. 

Aqua,  Iqt. 

20 


306  HALE   ON   ABORTION. 

Nitric  and  mwiatic  acids  might  be  beneficial  in  certain 
diseased  conditions  of  the  vagina  and  os  uteri,  and  per- 
fectly safe  as  well  as  reliable  for  the  purposes  desired. 

The  alkalies  might  be  advised  or  permitted  in  cer- 
tain cases.  It  is  said  by  Donne  that  when  the  secretion 
from  the  uterus  is  too  alkaline,  and  that  of  the  vagina 
too  acid,  they  destroy  the  life  of  the  spermatozoa  and 
thereby  induce  sterility. 

Astringents  have  always  enjoyed  the  most  extensive 
popularity.  They  are  resorted  to  by  women  in  all 
parts  of  the  world,  under  the  instinctive  idea  that  they 
contract  the  mouth  of  the  womb,  and  prevent  the  en- 
trance of  the  seminal  fluid.  If  this  was  the  extent  of 
the  action  of  astringents,  their  use  would  be  of  no  value  ; 
in  fact,  they  are  of  but  little  value  unless  used  in  such 
quantities  as  to  destroy  the  life  of  all  the  animalcules. 
Alum  is  the  most  commonly  used;  sulphate  of  zinc 
ranks  next  in  popularity.  Tannin,  and  vegetable  sub- 
stances containing  that  substance — namely,  geranium, 
oak-bark,  etc.,  have  all  been  used  with  success. 

Aconite,  gelseminum,  belladonna,  arnica,  and  ham- 
amelis,  might  each  be  recommended  for  the  purpose 
of  preventing  impregnation.  Each  would  destroy  the 
spermatozoa,  and  in  inflammatory  or  congested  condi- 
tions of  the  os,  cervix,  and  vagina,  would  prove  curative 
by  their  local  action. 

Injections  of  any  medicinal  solution,  or  even  of  very 
cold  water,  no  matter  how  destructive  they  may  be  to 
the  spermatozoa,  will  prove  useless  unless  they  are  used 
in  a  proper  manner.  It  will  not  suffice  to  use  them  in 
small  quantities,  or  hurriedly.  Neither  will  it  do  to 
wait  longer  than  two  or  three  minutes  after  coition. 

The  spermatozoa  are  very  active  when  mixed  with 
healthy  vaginal  mucus  ;  and,  in  women  who  have  borne 


OVULAK   ABORTION.  307 

children,  or  in  whom  the  cervical  canal  is  patent,  the 
animalcules  enter  the  os  uteri  by  their  own  volition  in 
an  incredibly  short  time.  They  also  become  lodged  in 
the  folds  of  the  vaginal  mucous  membrane,  where  they 
remain  unharmed  for  hours  or  days  if  the  enema  is  not 
most  thoroughly  used. 

The  injection,  to  be  effectual  for  the  prevention  of 
impregnation  by  destroying  the  spermatozoa,  must  be 
used  immediately  after  coition  ;  it  must  be  thrown  in 
with  considerable  force,  and  in  a  large  quantity,  in 
order  to  reach  the  animalcules  which  may  be  lodged  in 
the  mouth  of  the  womb,  or  the  rugse  of  the  vagina. 

The  ordinary  vaginal  syringe,  holding  but  a  few 
ounces,  is  not  a  proper  instrument,  unless  it  is  very 
large,  and  is  used  six  or  eight  times.  The  orifices  of 
all  vaginal  syringes  are  generally  too  small,  and  should 
be  enlarged.  The  most  appropriate  instrument  is  the 
Essex  syringe  with  an  extra  large  tube.  Not  less  than 
one  pint  of  water  should  be  used,  and  if  one  or  two 
quarts  is  thrown  up,  the  danger  of  impregnation  is 
materially  lessened  in  proportion. 

The  third  proposition  implies  the  use  of /ion-medicated 
fluids  thrown  into  the  vaginal  canal  for  the  purpose  of 
washing  away  all  the  animalcules  lodged  therein  during 
coition.  For  this  purpose  fluids  might  be  used 
which  were  not  inimical  to  the  life  of  the  spermatozoa, 
namely,  warm  water,  milk,  etc.,  and  if  a  sufficient 
quantity  was  used  would  probably  be  effectual.  There 
would  be  danger,  however,  that  the  bland  character  of 
these  fluids  would  preserve  the  life  of  a  few  of  the 
animalcules,  and  thus  allow  impregnation  to  take 
place. 

Cold  waiter  is  the  most  generally  useful  fluid  to  be 
used  as  an  enema.  It  should  be  used  immediately  after 


.".MS  HALE    ON    ABORTION. 

coition,  and  in  quantity  not  less  than  one  quart.  The 
temperature  need  not  be  lower  than  42°,  and  should 
not  be  higher  than  60°.  An  Essex  syringe,  throwing 
a  continuous  stream,  should  be  used,  and  the  water 
should  be  directed  to  all  parts  of  the  vagina,  particu- 
larly the  upper  portion,  around  the  cervix  uteri.  The 
best  position  for  the  woman  to  assume  is  the  sitting- 
posture,  on  the  side  of  a  stool  or  any  low  seat,  in  such 
a  position  that  the  water  when  thrown  up  will  gravitate 
downward  and  outward.  None  of  the  fluid  should  be 
allowed  to  remain  in  the  vagina. 

This  last  method  is  preferable  to  all  the  others,  as  a 
general  one.  No  risk  of  injury  is  incurred.  I  have 
never  known  but  one  instance,  where  cool  vaginal  injec- 
tions could  not  be  borne,  and  in  this  it  only  caused  a 
a  temporary  spasmodic  and  painful  action  of  the  uterus. 

There  is  but  one  condition  in  which  it  would  prove 
ineffectual ;  namely,  when  the  uterus  lies  so  low  in  the 
pelvis,  and  the  cervical  canal  so  ope^  as  to  permit  the 
entrance  of  the  seminal  fluid  into7  the  uterine  cavity 
during  the  act  of  coition.  In  this  state  of  the  organ, 
impregnation  could  hardly  be  prevented,  as  it  is  not 
always  safe  to  inject  fluids  into  the  cavity  of  an  unim- 
pregnated  uterus. 


TABULAR   VIEW. 


309 


The  following  TABLE  icitt  give  at  a  glance  the  condition  of  the  uterine  contents, 
and  the  treatment  to  be  adopted,  during  the  THREE  great  periods  of 
utero-gestation. 


From  conception  to  end  of 
third  month. 


From  end  of  third  month  to  I     From  end  of  sixth  month  to 
end  of  sixth.  full  term. 


Placenta 
oped. 


not     devel- 


Decidual     membrane 
adherent  to  the  uterus. 


Placenta  developed  and;    Placenta  developed  and 
attached  to  uterus.  attached  to  uterus. 


Decidual      membrane     Decidual      membrane 
non-adherent.  non-adherent. 


Contractile    power  of|    Contractile   power  of!    Uterus  capable  of  forc- 
the  uterus  too  feeble  to! uterus  capable,  in  some'ible    expulsive    contrac- 


expel  embryo,    etc.,    or 

instances,    of  expelling 

tions. 

arrest  haemorrhage. 

placenta  and  embryo. 

Haemorrhage  before  ex- 

Haemorrhage before  ex- 

Haemorrhage after  ex- 

pulsion of  after-birth. 

pulsion  of  after-birth. 

pulsion  of  after-birth. 

REMEDIES  FOB  HAEM- 

REMEDIES FOB  H.EM- 

REMEDIES  FOR  HAEM- 

ORRHAGE. —  Sabina,  erig- 

OBRHAGE.  —  Sabina,    cro- 

ORRHAGE. —  Secale,  caulo- 

eron, tanacetum,  arnica, 

cus,  erigeron,  erechthites, 

phyUin,    macrotin,   erig- 

hamamelis, trillium,  cin- 

secale, cinnamon,  ice,  and 

eron,  ice,  cold  and  hot 

namon,  ice,  cold  water, 

cold  or   hot  water,  gal- 

water, galvanism    (tam- 

hot water,  tampon,  sulph. 

vanism  tampon. 

pon  never).    Pressure  on 

acid. 

uterus,  or  manipulations 

with  the  hand. 

REMOVAL  OFDECIDTJA. 

REMOVAL  OF  AFTER- 

REMOVAL  OF  AFTER- 

— Blunt    hooks  —  forceps 

BIBTH.  —  Secale,  dry  cup- 

BIRTH. —  Forceps,    blunt 

—  injections. 

ping,    galvanism,  pulsa- 

hook,  secale,  caulophyttin, 

tilla,  caulophyUin,  macro- 

macrotin,  gossypium,  gal- 

• 

tin,  gossypium,  reflex  irri- 

vanism,    dry     cupping, 

tation   by  tampon,    etc.; 

uterine  irritation  by  cold 

blunt  hook,  forceps. 

water  or  the  hands  (tam- 

pon never). 

PART   VI. 
JURISPRUDENCE  OF  ABORTION. 


SECTION    I. 

The  consideration  of  the  Jurisprudence  of  Abortion, 
includes  the  moral  and  legal  bearings  of  both  obstetric 
and  criminal  abortion. 

I  cannot  commence  this  portion  of  the  work  in  a 
more  appropriate  manner  than  by  quoting  entire  a  Lec- 
ture delivered  by  my  venerable  friend  and  colleague, 
who  lately  occupied  the  chair  of  Medical  Jurisprudence 
in  Hahnemann  Medical  College. 

CRIMINAL  ABORTION: 

A  LECTURE  BEFORE  THE  CLASS  OF  HAHNEMANN  MEDICAL  COLLEGE,  DECEMBER,  1864. 

BY  PROF.  A.  E.  SMALL. 

Next  to  the  crime  of  infanticide  is  that  of  criminal  abortion.  It 
matters  not  by  whom  committed,  whether  by  the  mother  herself  or 
some  interested  friend,  nurse  or  physician.  The  procuring  of  abor- 
tion, under  all  circumstances,  is  a  direct  violation  of  the  laws  of 
the  physical  constitution,  and  almost  always  a  violation  of  that  holy 
commandment,  "  Thou  shalt  not  kill." 

Before  we  proceed  to  discuss  the  nature  of  this  crime  in  the  light 
of  reason,  and  in  reference  to  what  legislation  there  has  been  upon 
the  subject,  it  is  proper  to  test  its  heinousness  in  the  light  of  the 
moral  law,  which  regards  the  willful  killing  of  a  human  being,  at  any 
stage  of  its  existence,  as  nothing  short  of  murder.  When  we  consider 
the  fact  that  foetal  life  is  human  life,  distinct  from  that  of  the 
mother's,  and  dependent  upon  an  organization  as  distinct  from  that 
of  the  mother's  as  if  it  were  entirely  liberated  from  its  resting  place 
in  her  womb,  we  cannot  avoid  the  conclusion  that  the  destruction 
of  such  a  being  would  be  the  destruction  of  a  human  life,  and  that 
he  or  she  who  had  an  agency  in  perpetrating  the  deed  would,  in 
the  eye  of  the  moral  law,  be  guilty  of  murder.  In  order  to  gain  a 
better  understanding  of  the  bearings  of  the  subject,  abortion  in  the 
abstract  must  be  considered. 

To  begin  with  a  proper  definition — it  is  a  violent  and  premature 
expulsion  of  the  product  of  conception,  independently  of  its  age, 
viability  and  normal  formation.  In  the  investigation  of  the  subject 


314  HALE   ON   ABORTION. 

as  a  crime,  all  cases  of  abortion  that  result  from  natural  causes,  or 
the  result  of  accident,  or  justified  by  the  rules  of  medicine,  whether 
to  save  the  life  of  the  mother  or  her  child,  will  be  set  aside.  We 
shall  confine  our  discourse  to  such  cases  only  where  the  attempt  at 
premature  expulsion  of  the  product  of  conception  is  artificially 
unnecessarily  and  intentionally  made,  and  without  which  they  would 
not  otherwise  have  occurred. 

The  laws  of  the  land  do  not  recognize  that  unnecessary  abortion 
per  se  is  a  crime,  inasmuch  as  the  act  is  not  directed  against  the  life 
of  the  mother,  and  because,  too,  she  is  generally  a  party  to  the 
action  performed,  and  when  no  manifest  injury  or  loss  of  life  hap- 
pens to  the  mother,  it  is  regarded  a  mere  misdemeanor  ;  or,  if  other- 
wise, the  law  does  not  take  cognizance  of  the  act  as  a  capital 
offense. 

Able  authorities  upon  the  subject  have  pointed  out  the  inconsist- 
ency of  the  law  as  contemplating  the  crime  as  directed  against  the 
mother,  and  not  against  the  fetus,  when  in  fact  no  criminal  intent 
against  the  mother  can  be  affirmed,  but  against  the  foetus. 

The  act,  when  unnecessarily  performed,  manifestly  seems  to  have 
been  undertaken  from  one  of  two  reasons — either  to  prevent  the  pro- 
duct of  conception  from  receiving  life  ;  or  if  living,-  to  destroy  it.  - 
"We  shall  produce  evidence  to  show  that  the  former  cannot  be  the 
case,  and,  consequently,  that  the  latter  is  the  sole  intent  when 
the  act  is  committed. 

To  constitute  a  crime,  a  malicious  or  wicked  attempt  is  supposed 
to  exist,  and  as  the  intent  in  attempting  to  produce  abortion  is 
against  the  product  of  conception,  and  not  against  the  mother,  we 
cannot  but  regard  this  assumption  of  the  law  as  erroneous  ;  tending 
rather  to  increase  the  frequent  repetition  of  the  crime  instead  of 
exerting  a  wholesome  influence  against  it.  For  unless  the  woman 
die  in  consequence  of  the  attempt,  it  is  declared,  in  every  state  of 
pregnancy,  a  mere  misdemeanor  ;  or  where  injury  is  done  the  mother, 
not  necessarily  fatal  to  her  life,  the  crime  may  be  considered  a  felony, 
and  punishable  by  fine  or  temporary  imprisonment.  The  mag- 
nitude of  the  crime  against  the  second  human  victim  being  entirely 
overlooked. 

We  shall,  for  the  present,  omit  the  further  consideration  of  the 
subject  as  treated  both  in  common  and  statutory  law,  our  purpose 
being  to  show  that  abortion  is  primarily  a  crime  of  the  most  heinous 
character,  directed  with  malicious  intent  against  human  embryotic 
and  festal  life,  and  in  pursuing  this  course  we  shall  attempt  to  show 
the  fallacy  of  the  arguments  urged  by  interested  parties  in  extenua- 
tion of  the  offense. 

Excepting  all  accidental  and  necessary  cases  of  abortion,  it  must 
be  evident  that  abortions  must  be  intentional,  and  must  be  occa- 
sioned by  the  "  malice  aforethought  "  of  the  law.  It  has  been 
stated  that  the  malicious  intention,  unless  otherwise  shown,  is  not 
directed  against  the  mother,  but  against  the  product  of  her  womb. 
Hence  the  whole  criminality  of  the  offense  turns  on  this  one  fact — 


JURISPRUDENCE    OF   ABOETION.  315 

the  real  nature  of  the  fetus  in  utero.  If  the  foetus  be  a  lifeless  ex- 
cretion, however  soon  it  might  have  received  life,  the  offense  would 
have  been  of  minor  consequence. 

"  If  the  fcetus  be  already,  and  from  the  very  outset,  a  living 
human  being,  and  existing  independently  of  its  mother,  though  draw- 
ing its  substance  from  her,  its  destruction,  in  every  stage  of  preg- 
nancy, is  MURDER.  Every  act  of  procuring  abortion,"  rules  Judge 
Kihg,  of  Philadelphia,  "  contrary  to  the  usual  interpretation  of  the 
law,  is  murder,  whether  the  person  perpetrating  such  act  intended 
to  kill  the  woman,  or  merely  feloniously  to  destroy  the  fruit  of  her 
womb." 

In  Dr.  Storer's  contributions  to  Obstetric 'Jurisprudence  maybe 
found  a  complete  reply  to  the  plea  of  ignorance  of  the  nature  of  the 
crime,  which  is  often  urged  in  extenuation.  He  says  : 

''  Ignorance  of  the  law  is  held  no  excuse.  The  plea  of  ignorance 
of  guilt  could  hardly  better  prevail,  where  its  existence  is  implied 
by  common  sense,  by  analogy,  and  by  all  natural  instinct,  binding 
even  on  brutes.  *  *  *  Common  sense  would  lead  us  to  the 
conclusion  that  the  fcetus  is,  from  the  very  outset,  a  living  and  dis- 
tinct being.  It  is  alike  absurd  to  suppose  identity  of  bodies  and 
independence  of  life,  or  independence  of  bodies  and  identity  of  life  ; 
the  mother  and  the  child  within  her,  in  abstract  existence,  must  be 
entirely  identical  from  conception  to  birth,  or  entirely  distinct. 
Allowing,  then,  as  must  be  done,  that  the  ovum  does  not  originate 
in  the  uterus  ;  that  for  a  time,  however  slight,  during  its  passage 
through  the  Fallopian  tube,  its  connection  with  the  mother  is  wholly 
broken  ;  that  its  subsequent  history  is  one  merely  of  development, 
its  attachment  merely  for  nutrition  and  shelter — it  is  not  rational  to 
suppose  that  its  total  independence,  thus  once  established,  becomes 
again  merged  into  total  identity,  however  temporary  ;  or  that  life 
depending  on  nine  months'  growth,  or  on  birth,  because  confess- 
edly existing  long  before  the  latter  period — since  quickening  at 
least,  a  time  varying  widely  as  to  limits, — dates  from  any  other 
period  than  conception." 

"Another  argument  is  furnished  us,  but  differing.  The  fcetus, 
previous  to  quickening,  must  exist  in  one  of  two  states,  either 
death  or  life.  The  former  cannot  take  place,  nor  can  it  ever  exist 
except  as  a  finality.  If  its  signs  do  not  at  once  manifest  them- 
selves, as  is  generally  the  case,  and  the  fcetus  is  retained  in  utero, 
it  must  either  become  magnified  or  disintegrated — it  can  never  be- 
come vivified.  If,  therefore,  death  has  not  taken  place,  and  we  can 
conceive  no  other  state  of  the  fcetus  save  one,  that — namely,  life, 
must  exist  from  the  beginning." 

"  These  reasons  are  strengthened  by  the  reasonings  from  analogy. 
The  utter  loss  of  direct  influence  by  the  female  bird  upon  its  off- 
spring from  the  time  the  egg  has  left  her,  and  the  marked  effect 
originally  of  the  male.  The  independence  in  body,  in  movement  and 
in  life,  of  young  marsupial  mammals,  almost  from  the  very  moment 
of  their  conception,  identical  analogically  with  the  intra-uterine 


316  HALE    ON   ABORTION. 

state  of  other  embryos — nourishment  by  teat  merely  replacing  that 
by  placenta  at  an  earlier  period  ;  the  same  in  birds,  shown  by  move 
incuts  in  their  egg,  on  cold  emersion  before  the  end  of  incubation. 
The  permanence  of  low  vitality  or  of  impaired  or  distorted  nervous 
force,  arising  from  early  arrest  or  error  of  development,  and  neces- 
sarily contemporaneous  with  it,  are  all  instances  in  point." 

"  The  human  instinct,  unaided  by  reason,  invariably  leads  to  the 
protection  of  embryonic  and  foetal  life.  It  is  said  that  reason  sup- 
plants this  instinct  which  is  enjoyed  in  common  by  the  brutes.  But 
this  may  be  doubted,  inasmuch  as  the  absence  of  reason  in  idiots 
and  insane  persons  does  not  impair  the  maternal  instinct.  What- 
ever ideas  the  human  mind,  by  reasoning,  may  have  forced  itself  to 
believe  or  entertain,  let  the  slightest  proof  of  the  existence  of  foetal 
life  be  alleged,  and  maternal  instinct  at  once  makes  itself  known." 

Thus  far,  incidental  proof  concerning  the  commencement  of  foetal 
life,  and  consequently  the  manifest  guilt  of  unjustifiable  abortion, 
becomes  apparent.  If  there  exists  any  doubt  of  the  vitality  of  the 
contents  of  the  womb  in  early  pregnancy,  none  whatever  can  be 
cherished  after  the  period  of  quickening. 

This  period,  which  betokens  the  existence  of  a  living  fcetus  in 
the  womb  of  the  mother,  declares  emphatically  that  there  is  an  intra- 
uterine  life  that  may  be  destroyed  by  violent  hands  ;  that  this  posi- 
tive evidence  becomes  revealed  to  the  mother  by  unmistakable  sen- 
sations, is  universally  admitted  ;  and  this  accounts  for  the  fact  of 
abortions  being  much  more  rare  after  this  period  than  previous. 

But  singular  as  it  may  seem,  quickening  is  often  absent  through- 
out pregnancy,  and  other  evidences  are  relied  on  to  establish  the 
fact.  These  cases  are  confessedly  exceptions  to  the  rule.  In  most 
cases  of  pregnancy  it  does  occur,  but  varying  very  greatly  in  point 
of  time.  In  the  same  woman,  in  successive  seasons  of  pregnancy, 
the  period  of  quickening,  reckoning  from  conception,  has  varied 
from  fifteen  to  thirty  days.  In  the  .greater  number,  the  period 
occurs  from  the  one  hundred  and  twentieth  to  the  one  hundred  and 
thirtieth  day  after  conception.  But  from  infra-uterine  causes,  this 
period  may  be  lengthened  to  one  hundred  and  forty,  or  even  one 
hundred  and  fifty  days,  and  yet,  from  facts  which  cannot  be  disputed, 
the  foetus  is  living. 

"We  have  witnessed  premature  births  in  several  instances  where 
the  mother  was  in  doubt  of  her  situation  till  the  hour  of  parturition 
arrived.  Only  a  few  weeks  ago,  a  lady  who  had  been  married  two 
years  or  more  applied  for  counsel  in  reference  to  her  health,  stated 
that  she  had  not  menstruated  for  seven  months,  that  her  form  had 
changed  but  little,  and  that  at  no  time  had  she  been  conscious  of 
any  sensation  that  would  lead  her  to  suppose  that  she  had  been  car- 
rying in  her  womb  a  living  child.  At  the  same  time,  her  feet  were 
swollen,  which,  in  connection  with  other  signs  of  anasarca,  led  her 
to  believe  that  she  was  the  victim  of  disease  not  dependent  on  preg- 
nancy. Scarcely  a  week,  however,  elapsed,  before  there  was  ocu- 
lar demonstration  of  the  incorrectness  of  her  conclusions  ;  the  hour 
of  parturition  arrived,  and  she  gave  birth  to  a  livinf  child. 


JURISPRUDENCE    OF   ABORTION.  317 

In  premature  births,  where  quickening  has  not  occurred,  we  have 
the  most  positive  evidence  of  early  independent  and  vital  existence. 
These  births  sometimes  occur  previous  to  the  time  when  quickening 
may  be  looked  for,  and  in  some  instances  by  the  ear  there  is  conclu- 
sive evidence  to  be  gained  of  the  existence  of  a  living  being  in  utero, 
when  no  quickening  has  taken  place. 

It  will  be  conceded,  then,  that  the  period  of  manifest  quickening 
is  by  no  reasonable  conclusion  to  be  regarded  the  commencement  of 
foetal  life.  The  period  set  by  some  of  the  old  writers  was  the  third 
day  after  conception,  and  this  is  quite  as  reasonable,  and  yet  neither 
is  to  be  accredited  as  true. 

In  order  to  arrive  at  the  conclusion  that  embryotic  life  exists 
from  the  commencement  to  the  end  of  pregnancy,  it  is  not  necessary 
to  set  up  the  claim  of  sentience  and  will,  as  some  writers  have  done. 
For  while  perfection  of  endowment  does  not  exist  with  the  embryo, 
its  independent  life  can  be  conceded,  with  prophetic  endowments 
for  future  development,  in  the  womb  and  after  birth,  of  all  the 
attributes  of  human  perfection.  We  must  concede  this,  if  any- 
thing, for  how  can  the  embryo  merge  into  the  foetus  without  a  per- 
fectly independent  excito-motory  system,  distinct  from  that  of  the 
mother?  If  we  admit  this,  we  are  brought  directly  to  the  conclu- 
sion, that  the  existence  of  a  distinct  and  independent  nervous  cen- 
tre must  be  as  self-acting  and  living  as  that  of  the  mother. 

If  we  have  succeeded  in  proving  the  existence  of  foetal  life,  be- 
fore quickening  has  taken  or  can  take  place,  even  though  but  the  be- 
ginning of  undeveloped  faculties, — the  inalienable  rights  of  a  human 
being  are  implied,  and  this  should  compel  us  to  believe  that  unneces- 
sary abortion  is  a  crime. 

This  once  established,  we  are  struck  with  a  full  sense  of  human 
degradation  ;  mothers  imbruing  their  hands  in  their  infants'  blood  ; 
fathers  equally  guilty,  counseling  and  procuring  the  commission 
of  the  crime  ;  nurses  who  lend  themselves  to  the  infamy  ;  mem- 
bers of  the  medical  profession,  made  wicked  by  their  wholesale 
murders,  out-IIeroding  Herod — eclipsing  in  criminality  the  pirate 
upon  the  seas,  the  midnight  robber  or  highwayman ;  wretches  who 
make  this  kind  of  murder  a  trade  ;  who  go  forth  with  falsehood 
and  lies,  in  defiance  of  the  mandates  of  the  Almighty;  public  com- 
placency that  nurses  the  crime,  or  palliates  it,  or  with  insulting 
claims  of  legal  assumption  that  it  is  a  mere  misdemeanor  to  go  forth 
as  a  destroying  angel  to  prey  upon  human  life.  Who  can  uphold 
or  defend  so  common  a  violation  of  all  just  law,  human  and  divine  ? 
Who  can  justify  such  assault  upon  all  instinct  and  reason?  Let 
those  answer  who  would  seek,  if  they  could,  some  reasonable  excuse 
for  this  waywardness. 

That  criminal  abortion  is  carried  on  to  a  great  extent  in  our 
country,  is  indeed  probable,  and  that  it  is  carried  on  apparently  by 
those  having  high  claims  to  respectability,  we  also  admit,  and  fur- 
ther, we  admit  the  plausibility  of  the  motives  that  frequently  lead 
to  the  act ;  and  these  are  of  sufficient  importance  to  enter  concisely 


318  HALE    OX    ABORTION. 

into  our  discussion.  Does  not  the  motive  give  moral  quality  to  the 
act? — some  may  inquire.  "We  have  already  said  that  necessary  and 
justifiable  abortions,  in  accordance  with  the  rules  of  medicine,  are 
>.. in, -times  demanded.  The  lives  of  human  beings  are,  under  more 
cir.-umstan<-(><  than  a  few,  sacrificed  to  prevent  greater  evils.  But 
far  be  it  from  us  to  .offer  any  palliation  for  the  crime  of  murder. 
\Vli.-M  a  woman,  a  wife,  either  with  or  without  the  consent  of  her 
husband,  applies  to  an  abortionist  for  the  purpose  of  ridding  herself 
of  tin-  product  of  conception,  she  will  always  make  a  show  of  rea- 
son for  the  act,  by  attempting  to  show  a  necessity  for  it.  She  may 
set  up  the  claim  of  being  unable  to  have  the  responsibility  of  child- 
ren :  that  she  cannot  educate  them  or  keep  them  fed  and  clothed,  or 
above  degradation  ;  that  her  own  health  will  not  permit  it  ;  that  the 
period  of  gestation  subjects  her  to  confinement  and  keeps  her  from 
society,  and  she  might  as  well  be  dead  as  alive.  We  have  known 
some  physicians  to  listen  to  an  appeal  like  this,  and  yield  to  the  dic- 
tates of  a  blind  sympathy,  especially  when  a  generous  fee  was  forth- 
coming to  more  effectually  close  their  minds  against  all  sense  of  moral 
obligation,  and  plant  themselves  upon  the  flimsy  reasoning  of  such 
women,  and  while  prostrate  before  mammon  would  write  a  prescrip- 
tion for  some  powerful  deobstruent.  But.  they  lend  countenance  to 
crime  by  such  acts,  and  become  particeps  criminis  in  a  murderous 
transaction. 

Such  a  woman's  reasonings  are  as  baseless  as  a  fabric  upon  the 
sand.  She  has  a  husband  to  father  her  offspring,  a  Heavenly  Father 
to  protect  her  on  the  voyage  of  life,  and  in  all  probability  an  angel 
sent  for  her  future  comfort;  and  would  any  but  a  God- forsaken 
father  and  mother,  and  a  God-forsaken  physician,  ever  enter  into  a 
conspiracy  to  destroy  human  life  upon  such  flimsy  grounds?  Thou- 
sands of  cases  of  this  kind  are  constantly  occurring  in  the  large 
cities  and  towns  of  our  country,  to  enrich  such  female  wretches  as 
Mads.  Restell,  Beaumont  and  others,  who  levy  imposing  taxes  in 
order  to  support  them  in  the  crime.  By  all  that  is  human,  all  that 
is  noble  and  grand  in  the  attributes  of  true  manhood,  and  by  every 
consideration  that  relates  to  time  and  eternity,  every  honorable  phy- 
sician should  set  his  face  .against  this  practice,  and  hold  it  UP  as 
murder,  in  public  and  private.  Let  him  scorn  to  sympathize  with 
the  barbarity,  and  feel  that  fees  taken  for  such  agency  would  pro- 
duce an  uncomfortable  sensation  about  his  neck,  and  bind  him  as 
firm  as  fate  to  perdition. 

But  it  may  be  urged  that  illegitimate  pregnancy  is  a  different 
matter,  and  that  every  right-minded  physician  should  be  ready  to 
save  the  reputation  of  a  great  many  victims  of  this  sort  from  utter 
ruin,  and  their  families  from  disgrace.  A  mere  glance  at  the  crime 
of  abortion,  without  considering  its  heinous  nature,  might  cause  the 
unwary  physician  to  fall  into  temptation.  A  young"  lady  of  pre- 
vioug  good  reputation  has  fallen.  Will  it  raise  her  from  degrada- 
tion to  make  a  violent  assault  upon  the  intra-uterine  life  that  is  the 
fruit  of  her  imprudence,  or,  in  other  words,  would  any  physician 


JURISPRUDENCE  OF  ABORTION.         319 

feel  hinjself  worthy  of  saying  his  prayers  at  night,  after  he  had  lent 
his  hand  to  commit  a  deliberate  murder  to  save  the'  reputation  of  an 
already  disgraced  young  woman  ?  What  good  would  he  accomplish 
by  the  act  ?  Experience  proves  that  the  fallen  one  seldom  recovers, 
and  her  seducer  is  made  no  better,  and  the  physician  made  more  in- 
famous than  either. 

Such,  nevertheless,  should  command  our  sympathy,  and  we  should 
do  all  we  can  to  promote  their  temporal,  physical  and  moral  well- 
being.  And  we  can  do  much  in  that  direction,  if  we  regard  first  of 
all  our  duty  to  God  and  our  obligation  to  obey  all  just  laws,  both 
human  and  divine.  It  will  be  proper  to  guard  the  reputation  as  far 
as  we  can,  and  by  all  possible  means  consistent  with  divine  and 
human  laws.  But  God  forbid  that  we  should  do  evil  that  good  may 
come. 


I  cordially  and  sincerely  subscribe  to  most  of  the 
views  above  set  forth,  so  far  as  relates  to  the  destruc- 
tion of  the  ovum,  without  good  and  sufficient  cause.  I 
differ,  however,  with  some  of  my  professional  brethren, 
in  relation  to  the  propriety  of  inducing  abortion  or  pre- 
mature labor  when  certain  diseases  and  conditions  exist. 

I  hold  that  in  no  instance  should  the  life,  or  even 
health  of  the  mother  be  sacrificed  to  save  that  of  an  im- 
pregnated ovum,  before  the  date  of  its  "  viability." 

The  dogma  that  the  embryo,  before  that  date,  is  of 
the  same  importance  as  after,  is  yet  debatable.  I  can 
not,  therefore,  look  upon  the  destruction  of  the  ovum 
before  that  period  as  murder.  If  we  were  to  carry  the 
criminality  of  the  deed  back  to  the  period  of  impregna- 
tion, we  may  as  well  carry  it  back  to  the  period  of 
ovulation,  and  believe  with  the  ancient  Hindoos,  that 
the  voluntary  loss  of  an  unirnpregnated  ovum  was  a 
criminal  act.  According  to  Robertson,  early  marriages 
in  India  were  obligatory,  in  consequence  of  an  ancient 
theory  of  generation,  much  resembling  the  latest  modern 
ovarian  theory.  It  was  taught  that  if  an  unmarried 
girl  has  the  menstrual  secretion  in  her  father's  house, 
he  incurs  a  guilt  equal  to  the  destruction  of  the  foetus ; 


320  HALE   ON    ABORTION. 

for  the  girl  is  capable  of  conceiving,  and  should  be 
allowed  to  conceive ;  menstruation  being  the  loss  of  an 
ovum,  which  is  equivalent  to  the  loss  of  a  foetus. 

According  to  the  laws  of  the  Shastras,  females  must 
be  given  in  marriage  before  the  occurrence  of  mens- 
truation ;  and,  should  consummation  of  the  marriage 

'  O 

not  take  place  until  after  this  event,  the  marriage  is  a 
sin. 

These  ancient  doctrines  are  -not  to  be  treated  with 
indifference.  The  ovum,  is  the  receptacle  or  vehicle  of 
the  human  soul.  If  the  receptacle  is  voluntarily  allowed 
to  be  discharged  unimpregnated,  it  certainly  is  a  crimi- 
nal offence  in  a  certain  degree,  for  the  existence  of  a 
human  being  is  prevented. 

On  the  contrary,  lawgivers  or  physiologists  have  no 
right  to  establish  any  date,  anterior  to  viability,  after 
which  the  unnecessary  induction  of  abortion  is  a  crimi- 
nal offence. 

In  relation  to  this  subject,  I  herewith  present  a  paper 
on  the  subject  of  Criminal  Abortion,  prepared  by  my 
colleague,  Dr.  Charles  Woodhouse,  the  present  incum- 
bent of  the  chair  of  Medical  Jurisprudence  and  Insanity 
in  Hahnemann  Medical  College. 

CRIMINAL  ABORTION  — ITS  JURISPRUDENCE. 

In  our  remarks  on  this  branch  of  our  subject,  it  is  a  matter  of 
regret  that  the  laws  of  our  country  in  relation  to  it,  are  far  from 
being  all  that  the  interests  of  society  demand.  But  it  is  the  duty 
of  the  medical  man,  and  especially  the  medical  author,  to  do  what 
he  can  to  correct  these  mistakes,  and  supply  their  deficiencies.  It 
is  in  this  conviction  that  we  consider,  in  this  place,  this  momentous 
subject. 

In  medicine,  we  understand  by  abortion  the  expulsion  of  the 
foetus  before  the  sixth  month  of  gestation.  If  this  expulsion  takes 


JUKISPKUDEXCE    OF   ABORTION.  321 

place  between  the  sixth  and  ninth  month,  this,  in  medical  parlance, 
is  termed  miscarriage,  or  premature  labor.  The  popular  word  for 
both  is  miscarriage.  And  the  law  does  not  make  the  distinction 
made  by  medical  men.  In  many  instances  the  law,  unfortunately, 
recognizes  the  popular  falsehood,  that  a  woman  may  be  at  a  cer- 
tain point  of  time,  "  not  quick  with  child,"  and  in  the  next 
instant  "  quick  with  child,"  and  this  event  is  supposed  always  to 
take  place  several  months  after  conception.  It  is  needless  to  say, 
that  no  sound  physiologist  can  give  the  least  sanction  to  this  error ; 
an  error  fruitful  in  sin  and  crime,- however  venerable  for  age.  Law- 
makers, as  well  as  people,  need  enlightenment  on  this  matter. 
Those  who  believe  that  at  a  certain  period,  say  the  fourth  month 
after  conception,  the  fcetus  for  the  the  first  moment  begins  to  live, 
will  agree  that  it  is  no  moral  wrong  to  remove  it  before  that  time, 
and  justify  themselves  for  this  crime  on  this  false  ground.  But  a 
little  reflection  must  satisfy  the  reason,  that  the  fcetus  from  the 
beginning  must  exist  in  one  of  two  states,  life  or  death.  If  dead 
from  the  beginning  of  gestation,  that  death  is  a,  finality.  The  mother 
has  no  power  to  give  life  to  a  dead  fcetus  within  her.  If  the  fcetus 
is  alive  at  the  fourth  or  fifth  month,  or  in  any  period  of  utero-gesta- 
tion,  it  must  have  been  alive  from  the  beginning.  Unless  the  word 
"  quickening,"  in  connection  with  this  subject,  can  be  so  used  as  to 
guard  against  error,  it  had  better  not  be  used  at  all.  It  is  to  be 
hoped  that,  at  all  events,  the  absurd  distinction  of  "quick  and  not 
quick  with  child,"  will  soon  be  banished  from  the  legal  codes  of  all 
civilized  lands.  And  inasmuch  as  the  laws,  in  many  States,  do  not, 
(to  use  the  language  of  Storer),  "recognize  the  true  nature  of  the 
crime  of  abortion,  draw  unwarrantable  distinctions,  allow  many 
criminals  to  escape,  neglect  to  establish  a  standard  of  justification, 
and  in  many  respects  are  at  variance  with  equity  and  justice," 
every  true  physician  should  aim  to  perfect,  as  far  as  his  influence 
may  go,  codes  for  courts,  and  ideas  for  the  people,  until  the  Divine 
command,  "  Thou  shalt  not  kill."  shall  be  understood  to  apply  alike 
to  the  taking  away  of  all  human  life,  fcetal  or  otherwise. 

We  will  now  give  a  brief  view  of  some  of  the  laws  of  different 
countries  and  States,  on  abortion  : 

ENGLAND. — In  this  country  the  absurd  distinction  of  "  quick  and 
not  quick  "  is  now  done  away  with.  "Within  the  reign  of  the  pres- 
ent Queen  the  following  law  has  been  enacted :  "  Whosoever,  with 
the  intent  to  procure  the  miscarriage  of  any  woman,  shall  unlaw- 
fully administer  to  her,  or  cause  to  be  taken  by  her,  any  poison  01 

21 


HALE    ON    ABORTION. 

other  noxious  thing,  or  shall  unlawfully  use  any  instrument,  or 
othf  r  means  whatsoever,  with  the  like  intent,  shall  be  guilty  of 
felony,  and  being  convicted  thereof,  shall  be  liable  at  the  discretion 
of  the  court,  to  be  transported  beyond  the  seas  for  the  term  of  hi? 
or  her  natural  life,  or  for  any  term  not  less  than  fifteen  years,  or  to 
1)0  imprisoned  for  any  term  not  exceeding  three  years."  It  will  be 
seen  at  a  glance,  that  this  law  makes  no  exception  in  respect  to 
medical  men,  who  may  adopt,  for  any  purpose  or  with  any  motive, 
this  practice.  It  would  doubtless  be  essential  for  him  to  show,  in 
case  of  prosecution  for  this  offence,  that  his  motives  were  as  good 
as  those  of  the  surgeon's  in  amputating  a  badly  diseased  limb,  to 
«ave  himself  from  the  penalties  of  the  law.  The  English  law  is 
clearly  against  the  practice,  by  any  body. 

SCOTLAND. — Mr.  Allison,  a  late  writer  on  Scottish  law,  states  it 
thus  :  •'  If  a  person  gives  a  potion  to  a  woman  to  procure  abortion, 
and  she  die  in  consequence,  this  will  be  murder  in  the  person  giving 
it,  if  the  potion  was  of  that  powerful  kind  which  evidently  puts  the 
woman's  life  at  hazard."  Further,  "Administering  drugs  to  procure 
abortion  is  an  offence  at  common  law,  and  that  equally  whether  the 
desired  effect  be  produced  or  not."  In  1806  and  1823,  persons  who 
used  instruments  for  this  purpose,  were  sentenced  to  transportation 
for  this  offence.  However  it  may  be  in  actual  practice,  the  Scotch 
law,  as  given  by  Allison,  makes  no  exception  in  behalf  of  medical 
men.  Like  the  law  of  England,  it  shows  some  advance  in  a  right 
direction,  by  discarding  the  phrase,  "quick  and  not  quick,"  etc. 

FBAXCE. — The  Code  of  Napoleon  declares  that  every  person  who. 
by  means  of  ointments,  beverages,  medicines,  acts  of  violence,  or 
by  other  means,  shall  procure  the  untimely  delivery  of  a  pregnant 
woman,  although  with  her  consent,  shall  be  sentenced  to  confine- 
ment." The  mother  procuring  abortion  on  herself  is  similarly  pun- 
ished, under  the  same  code.  And  it  also  provides  that  "Physicians, 
surgeons,  apothecaries,  and  other  officers  of  health,  who  shall  pre- 
scribe or  administer  such  means  of  abortion,  shall,  if  miscarriage 
ensue,  be  sentenced  to  hard  labor  for  a  limited  time." 

AUSTRIA. — The  criminal  code  of  this  country,  established  in  1787, 
by  Joseph  II.,  decrees  that  a  woman  with  child,  using  means  to 
procure  abortion,  is  to  be  imprisoned  not  less  than  fifteen  years,  nor 
more  than  thirty,  and  condemned  to  the  public  works.  If  married, 
the  punishment  is  still  greater.  Even  advising  abortion  is  severely 
punished,  and  where  the  accomplice  is  the  father  of  the  infant,  the 
punishment  is  increased. 


JURISPRUDENCE    OF   ABORTION.  323 

GERMANY. — Deck  gives  the  following  summary  of  the  laws  of 
Germany :  If  produced  within  thirty  weeks  from  the  time  of  con- 
ception, the  woman  or  her  aiders  are  imprisoned  from  two  to  six 
years.  The  punishment  when  committed  in  the  last  month  of 
pregnancy,  is  imprisonment  from  eight  to  ten  years. 

ITALY. — The  laws  punish  the  woman  who  makes  the  attempt 
only,  to  confinement  from  six  months  to  a  year  ;  if  she  is  successful 
in  the  attempt,  she  is  confined  from  one  to  five  years.  If  the  father 
of  the  foetus  is  a  party  to  the  crime,  his  punishment  is  still  greater. 
The  party  attempting  abortion  against  the  will  of  the  mother  is 
punished  with  four  to  ten  years'  severe  imprisonment ;  and  if  the 
life  of  the  mother  is  endangered,  or  her  health  impaired,  the  impris- 
onment is  five  to  ten  years. 

STATE  OF  NEW  YORK. — The  laws  of  this  State,  on  abortion,  are 
now  embraced  in  three  sections,  one  of  which  provides  that  for  the 
willful  commission  of  this  crime,  by  medicine  or  instrument,  the 
offender  shall  be  imprisoned  in  the  county  jail  not  less  than  three 
months,  nor  over  one  year.  This  section  omits  the  distinction  of 
i(  quick  and  not  quick."  Another  section  provides  for  punishing 
the  offence,  committed  on  a  woman  quick  with  child,  with  intent  to 
destroy  the  child,  unless  necessary  to  save  the  life  of  the  mother. 
Otherwise  than  for  this  purpose,  if  either  child  or  mother  die  in 
consequence,  the  offence  is  manslaughter  in  the  second  degree,  and 
the  punishment  is  State  prison,  for  not  over  seven  nor  less  than 
four  years.  A  further  section  provides  that  the  willful  killing  of  an 
unborn  quick  child,  by  an  injury  to  its  mother,  which  would  be 
murder  if  it  resulted  in  her  death,  is  manslaughter  in  the  first  degree, 
and  the  penalty  is  State  prison  for  not  less  than  seven  years.  This 
great  State  has  for  its  motto  "  Excelsior,"  and  doubtless  may  for 
many  good  reasons  still  use  it ;  but  it  needs  to  follow  in  the  wake 
of  England  and  Scotland,  and  younger  sister  States,  in  discarding 
from  its  laws  on  abortion  the  pernicious  and  absurd  phrase,  "  quick 
and  not  quick,"  etc. 

STATE  OF  CONNECTICUT. — Here  this  absurd  distinction  of  "quick 
and  not  quick,"  still  remains,  but  the  crime  may  be  punished  by 
State  prison  for  life. 

STATE  OF  OHIO. — In  the  laws  of  this  State,  the  same  absurd  dis- 
tinction is  kept  up  as  in  New  York  and  Connecticut,  but  there  is  a 
provision  justifying  the  physician  in  saving  the  life  of  the  mother, 
even  at  the  expense  of  that  of  the  fcetus. 


324  HALE   ON   ABORTION. 

STATE  or  MASSACHUSETTS. — In  1845,  this  State  adopted  a  law, 
discarding  the  distinction  of  "quick,"  etc.,  and  providing  that  abor- 
tion, by  whatsoever  means  produced,  if  the  woman  die,  shall  be  pun- 
ished by  imprisonment  for  not  less  than  five  years,  nor  more  than 
twenty.  If  the  woman  do  not  die,  the  offence  is  a  misdemeanor, 
and  the  punishment  not  over  seven  years,  nor  less  than  one,  and  by 
a  fine  of  not  over  $2,000. 

STATE  OF  MISSOUBI. — The  penalty  for  this  crime  here  is  impris- 
onment not  over  seven  years,  and  a  fine  not  over  $3,000. 

STATE  OF  VIRGINIA. — This  offence  is  here  punished  by  confine- 
ment in  the  penitentiary  not  less  than  one  nor  over  four  years. 

In  all  these  named  States,  provisions  are  made  for  exempting 
from  punishment  any  physician,  or  other  person,  where  the  act  is 
done  in  good  faith,  with  intent  to  preserve  the  life  of  either  mother 
or  child.  (See  Beck.  Med.  Jurisprudence,  Vol.  I.,  page  584). 

STATE  OF  ILLINOIS. — In  the  laws  of  this  State,  the  absurd  dis- 
tinction alluded  to  is  not  retained.  The  punishment  is  confine- 
ment in  the  penitentiary  not  over  three  years,  and  a  fine  not  over 
$1,000. 

STATE  OF  IOWA. — From  the  year  1851  to  1858  there  were  in  this 
State,  strange  to  say,  no  laws  punishing  the  procurement  of  abor- 
tion. Prior  to  the  year  1851,  the  "willful  killing  of  an  unborn 
quick  child,  by  drugs  or  violence,"  was  punished  as  manslaughter. 
But  for  this  omission  of  duty  and  once  legal  recognition  of  the  false 
distinction  of  "quick  and  not  quick,"  etc.,  Iowa  has  nobly  atoned 
by  giving  a  very  good  law  (a  model  for  some  other  States)  on  this 
subject.  It  reads  as  follows  :  "  That  every  person  who  shall  will- 
fully administer  to  any  pregnant  woman  any  medicine^  drug,  sub- 
stance or  thing  whatever,  with  the  intent  thereby  to  procure  the 
miscarriage  of  any  such  woman,  unless  the  same  shall  be  necessary 
to  preserve  the  life  of  such  woman,  shall,  upon  conviction  thereof, 
be  punished  by  imprisonment  in  the  county  jail  for  a  term  not 
exceeding  one  year,  and  be  fined  in  the  sum  not  exceeding  one 
thousand  dollars." 

STATE  OF  CALIFOBNIA.— The  law  'against  abortion  in  California, 
says  The  Medical  and  Surgical  Reporter,  is  exceedingly  stringent.  It 
declares  that  the  person  on  whom  an  abortion  is  practised  shall  be 
held  as  guilty  as  the.  abortionist.  The  object  of  this  feature  of  the 
law  is  to  relieve  the  physician  of  vexatious  lawsuits,  to  which  he  is 
sometimes  subject  by  the  attempt  of  certain  wicked  females  to  fasten 
upon  him  criminal  abortion,  when  he  has  not  even  been  applied  to  at 


JURISPRUDENCE    OF   ABORTION.  325 

all  in  the  matter.  A  case  of  this  kind  is  said  to  have  occurred  in. 
San  Francisco,  and  illustrates  the  necessity  of  the  law  in  that  State, 
even  though  the  cases  which  may  occur  under  it  may  be  rare. 
Procuring  abortion  is  justly  regarded  as  a  crime  of  great  magnitude, 
and  the  laws  of  all  the  States,  so  far  as  we  are  informed,  inflict  upon 
the  perpetrator  of  it  a  heavy  penalty ;  and  the  law  is  right.  Its 
penalties  are  none  too  severe  ;  indeed  hardly  enough  so,  to  prevent 
its  occasional,  if  not  frequent  violation. 

These  citations  of  some  of  the  laws  on  abortion,  are  sufficient  to 
show  how  this  crime  is  viewed  in  different  States  and  countries,  and 
also  to  call  attention  to  such  improvements  in  them  as  the  facts  in 
physiology  and  the  authority  of  the  divine  law  shall  suggest  and 
require.  The  laws  should  in  no  case  create  or  perpetuate  the  dis- 
tinction of  "  quick  and  not  quick  with  child,"  as  it  is  repudiated  by 
right  reason  and  sound  physiology.  The  fact  should  also  be  pressed 
upon  the  attention  of  law-makers  that  a  pregnant  woman  may,  her- 
self, be  mistaken  as  to  whether  quickening  has  taken  place  or  not, 
and  that  she  may  bear  a  living  child  without  having  been  ever  con- 
scious of  quickening  having  ever  taken  place  in  her  case  at  all. 
The  laws  should  leave  no  loop-holes  for  the  escape  of  the  offender, 
who  knows  the  nature  and  enormity  of  the  crime  he  or  she  commits. 
One  State,  for  instance,  could  be  cited,  where  the  laws  are  perhaps 
sufficiently  severe  against  the  crime  of  abortion,  when  produced  by 
drugs,  but,  singularly  enough,  says  nothing  against  its  production  by 
instruments.  The  moralist  has  a  duty  to  do  in  the  premises,  and  all 
books  on  abortion  should  be  deemed  exceedingly  faulty,  which  do 
not  bear  testimony  against  this  evil,  and  help  to  aid  its  suppression. 

[Dr.  Woodhouse  has  obtained,  with  much  difficulty,  the  existing 
laws  relating  £o  abortion  in  the  States  above  mentioned.  In  the 
other  States  of  the  Union  we  cannot  ascertain  what  change,  if  any, 
has  been  made  in  their  laws  relating  to  criminal  abortion,  since  the 
date  of  the  work  on  that  subject  by  Dr.  Storer.] 

Dr.  Storer,  writing  in  I860,*  gives  the  following  as  the  laws  of 
the  various  States : 

"  In  the  following  States— Rhode  Island,  New  Jersey,  Pennsyl- 
vania, Delaware,  Maryland,  North  Carolina,  South  Carolina,  Geor- 
gia, Florida,  Kentucky,  Tennessee,  Iowa,f  and  the  District  of 
Columbia,  there  appear  to  exist  no  statutes  against  abortion,  and 

*  Criminal  Abortion,  p.  75.       f  Iowa  has  since  passed  a  very  good  law. 


HALE    ON    ABORTION. 


the  crime  can  only  be  reached  at  common  law  and  by  the  rulings  of 
the  courts." 

So  far  the  instances  in  this  country  of  an  absence  of  special  stat- 
utes. Where  such  exist,  they  may  be  variously  classified.  Reserv- 
ing for  a  little  all  other  considerations,  we  find  them  at  once  falling 
in  to.  four  great  divisions. 

1.  Those  acknowledging  the  crime  only  after  quickening  has 
occurred  : 

Connecticut,  Minnesota, 

Mississippi,  Oregon. 

Arkansas, 

II.  Those  acknowledging  the  crime  throughout  pregnancy,  but 
supposing  its  guilt   to  vary  with  the  period  to  which  this  has  ad- 
vanced : 

Maine,  Ohio, 

New  Hampshire,  Michigan, 

New  York,  Washington. 

III.  Those  acknowledging  the  crime  throughout  pregnancy,  un- 
mitigated ;  but  still  requiring  proof  of  the  existence  of  this  state  : 

Vermont,  Missouri, 

Massachusetts,  Alabama, 

Illinois,  Louisiana, 

•Wisconsin,  Texas, 

Virginia,  California. 
Kansas, 

IV.  That,  like  the  present  English  statute,  requiring  no  such 
proof,  and  punishing  also  the  attempt,  even  though  pregnancy  do 
not  exist : 

Indiana. 

Briefly  to  recapitulate  these  groups  : 

Maine,  Class  II. 

New  Hampshire,  "  II. 
Vermont,  "  III. 

Massachusetts,  "  III. 
Rhode  Island,  no  statute. 
Connecticut,  Class  I. 

New  York,  "    H. 

New  Jersey,  none. 

Pennsylvania,  none. 

Delaware,  none. 

Maryland,  none. 

District  of  Columbia,  none. 
Virginia,  Class  III. 

North  Carolina,  none. 
South  Carolina,  none. 
Georgia,  none. 

Florida,  none. 


Alabama, 

Class  III. 

Mississippi, 
Louisiana, 

I. 
"      III. 

Texas,          • 

"      III. 

Ohio, 

Class  II. 

Indiana, 

"     IV. 

Illinois, 

"     III. 

Michigan, 

"       II. 

Kentucky, 

none. 

Tennessee, 

none. 

Missouri, 

Class  III. 

Arkansas, 

I. 

Wisconsin, 

"      III. 

Iowa, 

none. 

Minnesota, 

Class     I. 

California, 

"     III. 

Oregon, 

I. 

JURISPRUDENCE    OF   ABORTION.  327 

MISSISSIPPI. — "  The  willful  killing  of  an  unborn  quick  child,  by 
any  injury  to  the  mother  of  such  child,  which  would  be  murder  if  it 
resulted  in  the  death  of  the  mother,  shall  be  deemed  manslaughter. 

"  Every  person  who  shall  administer  to  any  woman  pregnant  with 
a  quick  child,  any  medicine,  drug,  or  substance  whatever,  or  shall 
use  or  employ  any  instrument  or  other  means,  with  intent  thereby 
to  destroy  such  child,  unless  the  same  shall  have  been  necessary  to 
preserve  the  life  of  such  mother,  or  shall  have  been  advised  by  a 
physician  to  be  necessary  for  such  purpose,  shall  be  deemed  guilty 
of  manslaughter."*  Punishment,  by  fine  not  less  than  one  thou- 
sand dollars,  or  imprisonment  in  the  county  jail  for  not  more  than 
one  year,  or  in  the  penitentiary  for  not  less  than  two  years. 

ARKANSAS. — "  The  willful  killing  of  an  unborn  quick  child,  by 
any  injury  to  the  mother  of  such  child,  which  would  be  murder  if  it 
resulted  in  the  death  of  such  mother,  shall  be  adjudged  manslaughter. 

"  Every  person  who  shall  administer  to  any  woman  pregnant  with 
a  quick  child,  any  medicine,  drug,  or  substance  whatever,  or  shall 
employ  any  instrument  or  other  means,  with  intent  thereby  to 
destroy  such  child,  and  thereby  shall  cause  its  death,  unless  the 
same  shall  be  necessary  to  preserve  the  life  of  the  mother,  or  shall 
have  been  advised  by  a  regular  physician  to  be  necessary  for  such 
purpose,  shall  be  deemed  guilty  of  manslaughter."! 

MINNESOTA. —The  willful  killing  of  an  unborn  infant  child,  by  any 
injury  to  the  mother  of  such  ehild,  which  would  be  murder  if  it 
resulted  in  the  death  of  such  mother,  shall  be  deemed  manslaughter 
in  the  first  degree. 

;'  Every  person  who  shall  administer  to  any  woman  pregnant  with 
a  quick  child,  any  medicine,  drug,  or  substance  whatever,  or  shall 
use  or  employ  any  instrument  or  other  means,  with  intent  thereby 
to  destroy  such  child,  unless  the  same  shall  have  been  necessary  to 
preserve  the  life  of  such  mother,  or  shall  have  been  advised  by  two 
physicians  to  be  necessary  for  such  purpose,  shall,  in  case  the  death 
of  such  child  or  of  such  mother  be  thereby  produced,  be  deemed 
guilty  of  manslaughter  in  the  second  degree. "J  Punishment  for 
first  degree,  imprisonment  in  the  territorial  prison  for  not  less  than 
seven  years  ;  and  for  second  degree,  not  more  than  seven  years  nor 
less  than  four. 

MAIXE. — Whoever  administers  to  any  woman  pregnant  with  child, 
whether  such  child  is  quick  or  not,  any  medicine,  drug,  or  other  sub- 
stance, or  uses  any  instrument  or  other  means,  unless  the  same  were 
done  as  necessary  for  the  preservation  of  the  mother's  life,  shall  be 
punished,  if  done  with  intent  to  destroy  such  child,  and  thereby  it 
was  destroyed  before  birth,  by  imprisonment  not  more  than  five 
years,  or  by  fine  not  exceeding  one  thousand  dollars  ;  if  done  with 
intent  to  procure  the  miscarriage  of  such  woman,  by  imprisonment 

*  Revised  Code  of  Mississippi,  1857,  chap.  64,  p.  601. 
Digest  of  Statutes  of  Arkansas,  1848,  chap.  51,  p.  325. 
Revised  Statutes  of  Minnesota,  1851,  chap.  100,  p.  493. 


328  HALE    ON    ABORTION. 

•)  than  one  year,  and  by  fine  not  exceeding  one  thousand 
dollars.'* 

Xr.w  HAMPSHIRE. — "Every  person  who  shall  willfully  administer 
.  proirnant  woman  any  medicine,  drug,  substance  or  thing  what- 
•11  use  or  employ  any  instrument  or  means  whatever,  with 
thereby  to  procure  the  miscarriage  of  any  such  woman,  unless 
the  same  shall  have  been  necessary  to  preserve  the  life  of  such 
woman,  or  shall  have  been  advised  by  two  physicians  to  be  necessary 
for  that  purpose,  shall,  upon  conviction,  be  punished  by  imprison- 
ment in  the  county  jail  not  more  than  one  year,  or  by  a  fine  not 
exceeding  one  thousand  dollars,  or  by  both  such  fine  and  imprison- 
ment, at  thefliscretiou  of  the  court. 

"  Every  person  who  shall  administer  to  any  woman  pregnant  with 
a  quick  child,  any  medicine,  drug,  or  substance  whatever,  with  in- 
tent thereby  to  destroy  such  child,  unless  the  same  shall  have  been 
necessary  to  preserve  the  life  of  such  woman,  or  shall  have  been 
advised  by  two  physicians  to  be  necessary  for  such  purpose,  shall, 
upon  conviction,  be  punished  by  fine  not  exceeding  one  thousand 
dollars,  and  by  confinement  to  hard  labor  not  less  than  one  year  nor 
more  than  ten  years. 

••Any  person  who  shall  cause  the  death  of  any  pregnant  woman, 
in  the  perpetration  or  attempt  to  perpetrate  either  of  the  crimes 
mi'iitioned  in  the  two  preceding  sections,  or  in  consequence  of  the 
perpetration  or  the  attempt  to  perpetrate  either  of  said  crimes, 
shall  be  taken  and  deemed  to  be  guilty  of  murder  in  the  second 
degree,  and  be  punished  accordingly. 

"Any  woman  who  shall  voluntarily  submit  to  the  violation  of  the 
provisions  of  this  act  (this  and  the  three  preceding  sections!)  upon 
herself,  shall  be  punished  by  imprisonment  in  the  county  jail  not 
exceeding  one  year,  or  by  fine  not  exceeding  one  thousand  dollars, 
or  by  both  said  fine  and  imprisonment,  at  the  discretion  of  the 
court.  "J 

OHIO. — "Any  physician,  or  other  person,  who  shall  willfully  ad- 
minister to  any  pregnant  woman,  any  medicine,  drug,  substance,  or 
tiling  whatever,  or  shall  use  any  instrument,  or  other  means  what- 
ever, with  intent  thereby  to  procure  the  miscarriage  of  any  such 
woman,  unless  the  same  shall  have  been  necessary  to  preserve  the 
life  of  such  woman,  or  shall  have  been  advised  by  two  physicians  to 
be  necessary  for  that  purpose,  shall,  upon  conviction,  be  punished 
by  imprisonment  in  the  county  jail  not  more  than  one  year,  or  by 
fiiu-  not  exceeding  five  hundred  dollars,  or  by  both  such  fine  and 
imprisonment. 

••Any  physician,  or  other  person,  who  shall  administer  to  any 
woman,  pregnant  with  a  quick  child,  any  medicine,  drug,  or  sub- 
stance whatever,  or  shall  use  or  employ  any  instrument,  or  other 

*  Revised  Statutes  of  Maine,  1857,  chap.  124,  p.  685. 

+  The  above  should  evidently  read,  "the  first  two  sections,"  to  be  possible. 
:  Compiled  Statutes  of  New  Hampshire,  1853,  chap.  227,  p.  543. 


JUEISPEUDENCE  OF  ABOKTION.          329 

means,  with  intent  thereby  to  destroy  such  child,  unless  the  same 
shall  have  been  necessary  to  preserve  the  life  of  such  mother,  or 
shall  have  been  advised  by  two  physicians  to  be  necessary  for  such 
purpose,  shall,  in  case  of  the  death  of  such  child  or  mother,  in  con- 
sequence thereof,  be  deemed  guilty  of  a  high  misdemeanor,  and  upon 
conviction  thereof,  shall  be  imprisoned  in  the  penitentiary  not  more 
than  seven  years,  nor  less  than  one  year."* 

MICHIGAN. — "  The  willful  killing  of  an  unborn  quick  child,  by 
any  injury  to  the  mother  of  such  child,  which  would  be  murder  if  it 
resulted  in  the  death  of  such  mother,  shall  be  deemed  manslaughter. 

"Every  person  who  shall  administer  to  any  woman  pregnant  with 
a  quick  child,  any  medicine,  drug,  or  substance  whatever,  or  shall 
use  or  employ  any  instrument,  or  other  means,  with  intent  therebyv 
to  destroy  such  child,  unless  the  same  shall  have  been- necessary  to 
preserve  the  life  of  such  mother,  or  shall  have  been  advised  by  two 
physicians  to  be  necessary  for  such  purpose,  shall,  in  case  the  death 
of  such  child  or  of  such  mother  be  thereby  produced,  be  deemed 
guilty  of  manslaughter. 

"  Every  person  who  shall  willfully  administer  to  any  pregnant 
woman,  any  medicine,  drug,  substance,  or  thing  whatever,  or  shall 
employ  any  instrument,  or  other  means  whatever,  with  intent  there- 
by to  procure  the  miscarriage  of  any  such  woman,  unless  the  same 
shall  have  been  necessary  to  preserve  the  life  of  such  woman,  or 
shall  have  been  advised  by  two  physicians  to  be  necessary  for  that 
purpose,  shall,  upon  conviction,  be  punished  by  imprisonment  in  a 
county  jail  not  more  than  one  year,  or  by  a  fine  not  exceeding  five 
hundred  dollars,  or  by  both  such  fine  and  imprisonment."! 

VERMONT. — "  Whoever  maliciously  or  without  lawful  justifica- 
tion, with  intent  to  cause  and  procure  the  miscarriage  of  a  woman, 
then  pregnant  with  child,  shall  administer  to  her,  prescribe  for  her, 
or  advise  or  direct  her  to  take  or  swallow  any  poison,  drug,  medi- 
cine, or  noxious  thing,  or  shall  cause  or  procure  her,  with  like  intent, 
to  take  or  swallow  any  poison,  drug,  medicine,  or  noxious  thing  ; 
and  whoever  maliciously  and  without  lawful  justification,  shall  use 
any  instrument,  or  means  whatever,  with  the  like  intent,  and  every 
person  with  the  like  intent,  knowingly  aiding  and  assisting  such 
offenders,  shall  be  deemed  guilty  of  felony,  if  the  woman  die  in  con- 
sequence thereof,  and  shall  be  imprisoned  in  the  State  prison  not 
more  than  ten  years,  nor  less  than  five  years  ;  and  if  the  woman 
does  not  die  in  consequence  thereof,  such  offenders  shall  be  deemed 
guilty  of  a  misdemeanor,  and  shall  be  punished  by  imprisonment  in 
the  State  prison  not  exceeding  three  years,  nor  less  than  one  year, 
and  pay  a  fine  not  exceeding  two  hundred  dollars."]; 

WISCONSIN. — "  Every  person  who  shall  administer  to  any  preg- 
nant woman,  or  prescribe  for  any  such  woman,  or  advise  or  procure 

*  Revised  Statutes  of  Ohio,  1854,  chap.  162,  p.  296. 

f  Compiled  Laws  of  Michigan,  1857,  vol.  ii.  chap.  180,  p.  1509.  The  statute 
of  the  Territory  of  WASHINGTON  is  very  similar  to  those  above. 
\  Compiled  Statutes  of  Vermont,  1850,  chap.  108,  p.  560. 


330  HALE   ON   ABORTION. 

any  such  woman  to  take  any  medicine,  drag,  or  substance,  or  thing 
whatever,  or  shall  use  or  employ  any  instrument,  or  other  means 
whatever,  or  advise  or  procure  the  same  to  be  used,  with  intent 
thereby  to  procure  the  miscarriage  of  any  such  woman,  shall,  upon 
conviction,  be  punished  by  imprisonment  .in  a  county  jail,  not  more 
than  one  year  nor  less  than  three  months,  or  by  fine  not  exceeding 
fivi'  hundred  dollars,  or  by  both  fine  and  imprisonment,  at  the  dis- 
cretion of  the  court. 

"Every  woman  who  shall  take  any  medicine,  drug,  substance,  or 
thing  whatever,  or  who  shall  use  or  employ  any  instrument,  or  shall 
submit  to  any  operation,  or  other  means  whatever,  with  intent  to 
procure  a  miscarriage,  shall,  upon  conviction,  be  punished  by  impris- 
onment in  a  county  jail  not  more  than  six  months,  nor  less  than  one 
month,  or  by  .a  fine  not  exceeding  three  hundred  dollars,  or  by  both 
fine  and  imprisonment,  at  the  discretion  of  the  court."* 

ALABAMA. — "Any  person  who  willfully  administers  to  any  preg- 
nant woman,  any  drug  or  substance,  or  uses  and  employs  any  instru- 
ment or  other  means  to  procure  her  miscarriage,  unless  the  same  is 
necessary  to  preserve  her  life,  and  done  for  that  purpose,  must,  on 
conviction,  be  fined  not  more  than  five  hundred  dollars,  and  impris- 
oned not  less  than  three  nor  more  than  twelve  months. "f 

LOUISIANA. — "Whoever  shall  feloniously  administer,  or  cause  to 
be  administered,  any  drug,  potion,  or  any  other  thing,  to  any  woman, 
for  the  purpose  of  procuring  a  premature  delivery,  and  whoever  shall 
administer,  or  cause  to  be  administered,  to  any  woman  pregnant  w'ith 
child,  any  drug,  potion,  or  any  other  thing,  for  the  purpose  of  pro- 
curing abortion,  or  a  premature  delivery,  shall  be  imprisoned  at  hard 
labor  for  not  less  than  one,  nor  more  than  ten  years. "J 

TEXAS. — "  If  any  person  shall  designedly  administer  to  a  pregnant 
woman,  with  her  consent,  any  drug  or  medicine,  or  shall  use  toward 
her  any  violence,  or  any  means  whatever,  externally  or  internally 
applied,  and  shall  thereby  procure  an  abortion,  he  shall  be  punished 
by  confinement  in  the  penitentiary  not  less  than  two  nor  more  than 
five  years ;  if  it  be  done  without  her  consent,  the  punishment  shall 
be  doubled. 

"Any  person  who  furnishes  the  means  for  procuring  an  abortion, 
knowing  the  purpose  intended,  is  guilty  as  an  accomplice. 

"If  the  means  used  shall  fail  to  produce  an  abortion,  the  offender 
is  nevertheless  guilty  of  an  attempt  to  procure  abortion,  provided  it 
be  shown  that  such  means  were  calculated  to  produce  that  result, 
and  shall  receive  one-half  the  punishment  prescribed. 

f  the  death  of  the  mother  is  occasioned  by  an  abortion  so  pro- 
duced, or  by  an  attempt  to  effect  the  same,  it  is  murder. 

*  Revised  Statutes  of  Wisconsin,  1858,  chap.  169,  sect.  58.    It  will  be 
I  that  the  second  section  of  the  above  statute  differs  from  the  first,  in 
requiring  the  proof  of  pregnancy. 

f  Code  of  Alabama,  1852,  sect.  3230,  p.  582. 

vised  Statutes  of  Louisiana,  1856,  p.  138.  By  its  wording,  this  statute 
might  be  forced  into  the  next  division. 


JURISPRUDENCE    OF   ABORTION.  331 

"If  any  person  shall,  during  the  parturition  of  the  mother,  destroy 
the  vitality  or  life  of  a  child,  which  child  would  otherwise  have  been 
Lorn  alive,  he  shall  be  punished  by  confinement  in  the  penitentiary 
for  life,  or  any  period  not  less  than  five  years,  at  the  discretion  of 
the  jury.* 

"Nothing  contained  in  this  chapter  shall  be  deemed  to  apply  to 
the  case  of  an  abortion  procured,  or  attempted  to  be  procured,  by 
medical  advice  for  the  purpose  of  saving  the  life  of  the  mother. "f 

INDIANA. — "  Every  person  who  shall  willfully  administer  to  any 
pregnant  woman,  or  to  any  woman  whom  he  supposes  to  be  pregnant, 
anything  whatever,  or  shall  employ  any  means  with  intent  thereby 
to  procure  the  miscarriage  of  such  woman,  unless  the  same  is  neces- 
sary to  preserve  her  life,  shall  be  punished  by  imprisonment  in  the 
Bounty  jail  not  exceeding  twelve  months^and  be  fined  not  exceeding 
five  hundred  dollars. "J 

KAXSAS. — "  Every  physician  or  other  person  who  shall  willfully 
administer  to  any  pregnant  woman,  any  medicine, .drug,  or  substance 
whatever,  or  shall  use  or  employ  any  instrument  or  means  whatso- 
ever, with  intent  thereby  to  procure  abortion,  or  the  miscarriage  of 
any  such  woman,  unless  the  same  shall  have  been  necessary  to  pre- 
serve the  life  of  such  woman,  or  shall  have  been  advised  by  a  physi- 
cian to  be  necessary  for  that  purpose,  shall,  upon  conviction,  be 
adjudged  guilty  of  a  misdemeanor,  and  punished  by  imprisonment 
in  a  county  jail  not  exceeding  one  year,  or  by  fine  not  exceeding 
five  hundred  dollars,  or  by  both  such  fine  and  imprisonment."  || 

After  commenting  on  the  imperfections  of  the  laws  of  the  States 
relating  to  criminal  abortion,  Dr.  Storer  makes  the  following  just 
remarks  : 

"  If  our  previous  assumptions  of  the  actual  character  of  criminal 
abortion  be  granted,  and  we  believe  that  they  have  been  proved  to  a 
demonstration,  it  must  follow  from  the  subsequent  remarks  that  the 
common  law,  both  in  theory  and  in  practice,  is  insufficient  to  control 
the  crime  ;  that  in  many  States  of  this  Union  the  statutory  laws  do 
not  recognize  its  true  nature  ;  that  they  draw  unwarrantable  dis- 
tinctions of  guilt ;  that  they  are  not  sufficiently  comprehensive, 
directly  allowing  many  criminals  to  escape,  permitting  unconsum- 
mated  attempts,  and  improperly  discriminating  between  the  meas- 
ures employed  ;  that  they  require  proofs  often  unnecessary  or  impos- 
sible to  afford  ;  that  they  neglect  to  establish  a  standard  of  justifi- 

*  I  insert  this  clause  not  merely  for  its  relation  to  the  points  we  are  now 
considering,  but  for  its  important  bearing  on  the  broad  question  of  infanticide 
during  labor;  concerning  which  it  stands  in  bold  and  direct  antagonism  to 
all  the  rulings  of  the  common  law  in  this  country  and  abroad.  In  other 
respects  also,  though  not  faultless,  the  Texas  statute  is  rationally  and  admir- 
ably drawn. 

t  Penal  Code  of  Texas,  1857,  p.  103. 

i  Revised  Statutes  of  Indiana,  1852,  p.  437. 

J  Statutes  of  Kansas,  1855,  chap.  48,  p.  243. 


332  HALE    ON   ABORTION. 

cation,  and  thereby  sanction  many  clear  instances  of  the  crime  ;  that 
by  a  system  of  punishments  wholly  incommensurate  with  those 
inflicted  for  all  other  offences  whatsoever,  they  thus  encourage 
instead  of  prevent  its  increase;  and  that  in  many  respects  they 
are  at  variance,  not  merely  with  equity  and  abstract  justice,  but 
with  the  fundamental  principles  of  law  itself. 

"  '  It  is  to  be  hoped,'  has  forcibly  been  written,  '  that  the  period 
is  not  far  remote,  when  laws  so  cruel  in  their  effects,  so  inconsistent 
with  the  progress  of  knowledge  and  civilization,  and  so  revolting 
to  the  feelings  and  claims  of  humanity,  will  be  swept  from  our 
statutes.'* 

"  In  a  similar  trust,  it  now  behooves  us  to  consider  whether,  and 
in  what  manner,  the  difficulties  in  the  way  of  generally  suppressing 
the  crime  of  abortion  can  Ije  overcome. 

*     CAN  IT  BE  AT  ALL  CONTROLLED  BY  LAW? 

"  To  this  important  question  I  do  not  hesitate  to  give  an  unqualified 
answer  in  the  affirmative.  The  fact  that  criminal  abortion  is  not 
controlled  by  law  anywhere,  cannot  be  entertained  as  a  valid  argu- 
ment to  the  contrary  of  this  assertion ;  for  it  is  equally  the  fact,  as 
we  have  seen,  that  laws  against  abortion  do  not  as  yet  exist,  which 
are  in  all  respects  just,  sufficient,  and  not  to  be  evaded. 

•'  It  is  evident  that  in  aiming  to  suppress  this  crime,  the  law  should 
provide  not  merely  for  its  punishment,  but  indirectly  as  well  as 
directly,  and  so  far  as  possible,  for  its  prevention.  The  punishment 
of  a  crime  cannot  be  just,  if  the  laws  have  not  endeavored  to  prevent 
that  crime  by  the  best  means  which  times  and  circumstances  would 
allow.f  and  this  is  to  be  accomplished  by  a  twofold  process  —  by 
rendering  on  the  one  hand  its  detection  more  probable,  and  on  the 
other  its  punishment  more  certain. 

As  indirect  though  important  measures  for  the  former  of  these 
ends,  we  have  already  mentioned  laws  for  registration,^  and  against 

*  LEE,  note  to  Guy's  Principles  of  Forensic  Medicine,  p.  134. 

f  BECCARI,  Crimes  and  Punishments,  104. 

f  "An  efficient  and  practical  remedy  for  the  prevention  of  this  crime  would 
be  a  law  requiring  the  causes  of  death  to  be  certified  by  the  physician  in 
attendance,  or  where  there  has  been  no  physician,  by  one  called  in  for  the 
purpose.  In  this  way  the  cause  of  death,  both  in  infants  and  mothers,  could 
be  traced  to  attempts  to  procure  abortion.  In  three  cases  which  occurred 
in  Boston  in  1855,  the  death  was  reported  by  friends  to  be  owing  to  natural 
causes,  and  in  each  it  was  subsequently  ascertained  that  the  patient  died  in 
consequence  of  injuries  received  in  procuring  abortion.  It  is  probable  that 
such  cases  are  by  no  means  rare ;  and  if  the  cause  of  death  were  known,  an 
immediate  investigation  might  lead  to  the  detection  of  the  guilty  party ." — 
(Boston  Med.  and  Surg.  Journal,  Dec.  1857,  p.  365.) 

[NOTE. — There  is  no  law  of  the  State  of  Illinois  against  the  concealment 
of  births,  and,  we  believe,  none  against  secret  burials.  In  this  city  (Chicago) 
there  is  also  no  ordinance  against  the  concealment  of  births  ;  and  although 
there  is  an  ordinance  providing  for  the  registration  of  deaths,  and  against 
secret  burials,  yet,  owing  to  the  culpable  neglect  of  the  city  authorities,  the 


JUEISPETTDENCE    OF   ABOETION.  333 

concealment  of  births  and  secret  burials.  As  a  single  proof  of  their 
possible  influence  in  this  respect,  out  of  many  that  might  be  adduced, 
we  instance  the  fact  that  in  Paris  the  number  of  premature  foetuses 
deposited  at  the  Morgue,  during  the  nine  years  from  1846  to  1854, 
inclusive,  was  found  to  exceed  by  more  than  two-thirds  that  of  the 
full  decade  just  preceding,  from  1836  to  1845.*  To  render  this  dif- 
ference more  apparent,  we  have  compiled  the  following  table  : 

Age  of  Foetuses  deposited.  Ten  years :  Nine  years : 

1836  to  1845.  1846  to  1854. 

From  2  to  3  months 21  58 

"     3  to  4       " 35  73 

"     4  to  5       " 56  102 

"     5  to  6       "        69  82 


Total 181  315 

"  Part  of  this  advance,  it  is  true,  is  attributable  to  the  increase  in 
the  population  of  Paris,  and  in  the  prevalence  of  criminal  abortion ; 
but  in  great  measure  it  is  clearly  owing  to  the  enforcement  of  a 
more  rigid  .law  against  secret  burials.  The  above  remarks'  are 
strikingly  corroborated  by  the  fact  that  of  trials  for  the  crime — and 
we  must  not  forget  that  these  bear  but  a  small  ratio  to  the  whole 
number  of  cases  preliminarily  investigated! — there  were  in  France, 
during  the  latter  of  these  periods,  fully  four  times  the  number 
occurring  from  1836  to  1845. 

"  The  establishment  of  foundling  hospitals,  by  the  State  govern- 
ments, has  been  urged  as  a  preventive  of  the  crime,  and,  on  the 
other  hand,  fears  have  been  expressed  lest  the  same  means  should 
increase  it.  For  ourselves,  however,  and  from  some  experience  in 

law  is  almost  a  dead  letter.  Not  only  do  the  undertakers  neglect  to  report 
many  cases  of  burial,  but  they  are  unwarrantably  permitted  to  report  to  the 
health  officer  on  the  causes  of  death  !  In  consequence  the  reports  of  that 
officer  are  a  standing  disgrace  to  any  civilized  community,  on  account  of  the 
gross  ignorance  which  they  expose.  Not  only  this,  but  they  undoubtedly 
hide  a  vast  amount  of  crime,  behind  their  unmeaning  and  unscientific  terms. 
We  will  take  as  an  example,  the  yearly  record  of  the  city  mortality  for 
1865.  The  whole  number  of  deaths  for  that  year  were  3,659.  Of  this 
number  the  following  are  set  down  as  the  causes  of  death : 

Congestion  (!!) 90 

Cramps    (!!!!)    183 

What  was  the  matter  with  these  183  persons,  who  died  of  "cramps?" 
and  the  90  who  died  of  "  congestion  ?  "  Is  it  not  disgraceful  that  such 
returns  are  permitted  in  a  civilized  city  ?  How  many  of  these  deaths  were 
really  from  criminal  causes  ?  How  many  resulted  from  criminal  abortion  ? 
This  is  only  known  to  the  All-seeing  JSye,  and  the  guilty  ones.  Tltere  were 
also  132  still-born  infants  buried  in  1865.  Did  all  these  die  natural  deaths? 
Does  any  one  suppose  that  this  small  number  includes  all  the  still-born  of 
this  great  city? — HALE.] 

*  Register  of  the  Morgue. 

f  From  1846  to  1850, 188  cases  of  criminal  abortion  were  discovered  in 
Paris,  but,  for  want  of  proof,  only  22  of  them  were  sent  to  trial.  (Comptes 
Mendus  Ann.  de  la  Justice  Criminelle.) 


334  HALE   ON   ABORTION. 

such  cases,  we  believe  that  these  fears  are  groundless,  and  that  with 
equal  justice  might  they  be  entertained  of  every  large  charity 
having  for  its  end  the  improvement,  sanitary  or  otherwise,  of  the 
masses  of  society. 

"  We  have  quoted  a  statute  existing  in  Massachusetts,  though 
practically  unenforced,  against  one  great  agent  in  the  increase  of 
abortion,  an  abuse  pf  its  license  by  the  public  press.  Were  such 
laws  to  become  general,  and  to  be  faithfully  executed,  and  were  it 
also  made  penal  to  sell  any  drug,  popularly  known  as  emmenagogue, 
except  as  advised  by  physicians,  just  as  the  sale  of  direct  poisons  is, 
or  should  be,  controlled  by  law,  the  present  system  of  openly 
advertising  by  abortionists,  would  undoubtedly  be  brought  to  a 
close. 

"In  no  matter  is  it  of  more  importance  than  in  cases  of  suspected 
criminal  abortion  that  coroners  should  be  intelligent  and  well  edu- 
cated medical  men  ;  and  we  could  wish  that  this  point  might  have 
received  especial  attention  from  Dr.  Semmes,  in  his  late  admirable 
report  to  the  American  Medical  Association.*  In  the  sudden  excite- 
ment of  an  inquest,  the  guilty  are  more  likely  than  at  a  later  period 
to  be  off  their  guard,  and  evidence  may  often  be  elicited  at  this  time. 
which,  at  the  subsequent  trial,  it  would  be  impossible  to  obtain. 
There  can  be  no  question  of  the  importance  of  this  point ;  the  coro- 
ner should  be  skilled  in  all  that  pertains  to  obstetric  jurisprudence  ; 
and  if  similar  knowledge  were  generally  possessed  by  other  officers 
of  justice,  attorney,  juror,  and  judge,  a  far  greater  number  of  con- 
victions, under  a  proper  law,  would  be  secured. 

"  As  regards  the  more  direct  statutes,  we  have  already  considered 
their  important  points.  -;''•* 

" '  In  order  to  render  laws  effectually  preventive,'  as  has  wisely  been 
said,  '  they  should  be  consistently  framed,  and  based  on  justice. 'f 
In  accordance  with  this  truly  axiomatic  doctrine,  and  with  various 
rulings  of  the  courts,  already  quoted,  no  proof  should  be  demanded 
which  is  not  necessitated  by  the  actual  character  of  the  crime.  We 
have  seen  that  neither  in  intent  nor  in  fact  is  this  an  attempt  against 
the  person  or  life  of  the  mother.  If  she  die  in  consequence,  the 
offender  is  already  amenable  for  it  as  homicide  ;  in  the  absence  of 
any  special  statute,  at  common  law.  The  crime  both  in  intent  and 
in  fact,  is  against  the  life  of  the  child. 

"  The  attempt  being  proved,  it  is  unnecessary  that  it  should  have 
been  consummated,  not  merely  the  completion  of  a  crime  bringing 
its  punishment,  but  also  certain  overt  acts  with  intent  to  the  per- 
petration ;  nor  is  it  requisite  that  any  injury,  specific  or  general, 
should  have  been  inflicted  upon  the  person  of  the  mother. 

"  The  offence  being  of  equal  guilt  throughout  pregnancy,  proof  of 
quickening,  the  incident,  not  the  inception  of  vitality, — indicating 
neither  the  commencement  of  a  new  stage  of  existence,  nor  an 

*  Report  on  the  Medico-legal  Duties  of  Coroner.    1857. 

f  RAUKOKD,  British  Record  of  Obstetric  Medicine,  vol.  i.  p.  55. 


JURISPRUDENCE  OF  ABORTION.         335 

advance  from  one  stage  to  another,* — and,  therefore,  an  element 
without  the  slightest  intrinsic  value,  should  not  be  required. 

"  The  crime  of  abortion  should  be  considered  to  include,  as  it  does, 
in  the  absolute  fact  of  moral  guilt,  all  cases  of  attempted  or  intention- 
ally effected  destruction  and  miscarriage  of  the  product  of  impreg- 
nation ;  and  this,  whether  it  be  living  or  dead,  normal  or  abnormal, 
which  last  expression  equally  comprehends  instances  of  moles, 
hydatids,  extra-uterine  conception,  acephalous,  anencephalous,  and 
other  monsters. 

"  Proof  should  not,  as  now,  be  required  of  intent  to  destroy  the 
child. f  This  should  be  considered  shown  by  the  intent  to  produce 
miscarriage,  in  .the  absence  of  lawful  justification  therefor;  the  act 
in  all  stages  of  pregnancy  being  attended  with  great  danger  to  the 
child,  and,  in  much  more  than  a  moiety  of  the  period,  necessarily 
fatal  to  it. 

"  The  attempt  being  considered  criminal,  it  follows  that  proof  of 
pregnancy  is  not  necessary,  and  that  conviction  should  be  had 
though  it  were  proved  that  pregnancy  did  not  exist,|  even  that  the 
woman  on  whom  the  abortion  was  attempted,  however  unlikely,  was 
still  a  virgin. || 

"  No  discrimination  should  be  made  as  to  the  means  criminally 
employed,  and  no  escape  thus  afforded  to  the  guilty ;  as  we  have 
seen  still  obtaining  in  Great  Britain  and  many  of  our  own  States. 

"  The  mother,  almost  always  "an  accessory  before  the  fact,"  or 
the  principal,  should  not,  as  now,  be  allowed  almost  perfect  im- 
punity. There  is  no  valid  reason  for  such  exemption  ;  there  is 
every  reason  against  it.  The  woman  is  covered  by  the  laws  of  most 
continental  nations  of  Europe — France,  Austria,  Germany,  Bava- 
ria, and  Italy, — and  by  many  of  them  her  punishment,  if  married, 
is  greatly  increased.  ^Similar  severity  is  also  exercised  in  these 
countries  against  the  father  of  the  foetus,  if  he,  too,  is  implicated  in 
the  crime. 

"  To  allow  that  abortion  is  extenuated  in  the  unmarried,  it  has 
been  said,  will  'to  the  moral  and  political  philosopher  appear  to  have 
exalted  the  sense  of  shame  into  the  principle  of  virtue,  and  to  have 
mistaken  the  great  end  of  penal  law,  which  is  not  vengeance,  but 
the  prevention  of  crime.  Law,  which  is  the  guardian  and  bulwark 
of  the  public  weal,  must  maintain  a  steady  and  even  rigid  watch 
over  the  general  tendencies  of  human  actions. "§  But,  on  the  other 
hand,  the  measure  of  punishment  should  be  proportionate,  as  nearly 
as  possible,  to  the  temptation  to  offend,  and  to  the  kind  and  degree 
of  evil  produced  by  the  offence. "^[ 

"  We  have  seen  the  increase  in  moral  guilt,  and  of  opportunity  for 
commission  and  for  escape,  in  the  case  of  nurses,  midwives,  and 

*  \VHARTOX,  Criminal  Law,  540. 

•f  Smith  vs.  The  State,  33  MAINE,  (3  RED.)  48. 

\  Rex  vs.  Phillips ;  Regina  vs.  Goodall ;  Regina  vs.  Heynes,  etc. 

|  TAYLOR,  Medical  Jurisprudence,  p.  386. 

§  PERCIVAL,  Medical  Ethics,  p.  84. 

1  Ibid,  p.  85. 


336  HALE   ON   ABORTION. 

other  classes  of  persons,  who,  from  their  profession,  are  brought 
more  directly  into  contact  with  pregnant  women.  By  the  penal 
code  of  Napoleon  the  First,  remarkable  in  so  many  respects  for  the 
wisdom  of  its  provisions,  an  increase  of  punishjnent  was  enacted  for 
abortion  criminally  induced  or  advised  by  physicians,  surgeons,  or 
other  officers  of  health,  including  midwives,  or  by  druggists  ;*  their 
guilt  being  enhanced  by  their  greater  opportunities  and  knowledge. 

<;  Punishments  for  the  crime  of  abortion  should  not,  as  is  now 
generally  the  case,  be  so  framed  as  to  render  the  statute,  in  fact,  if 
not  in  name,  simply  nugatory.  Were  the  murder  of  adults  to  be 
made  answerable  by  merely  a  year  or  two  in  prison,  far  more  con- 
victions than  at  present  would  undoubtedly  be  secured  ;  but  it  is 
certain  that  the  instances  of  the  crime  would  be  fearfully  increased. 
We  have  reason  to  believe  that  it  is  precisely  thus  with  the  case  in 
hand. 

"  A  standard  of  justification  for  the  instances  of  necessary  abor- 
tion should  be  fixed  by  law.  If  perfection  in  this  respect  be  impos- 
sible, let  the  nearest  approach  be  made  to  it  that  can.  Since  my 
remarks  upon  the  relative  rights  of  the  mother  and  fetus,  to  the 
chance  of  life  in  doubtful  cases,  were  published  in  a  former  paper  of 
the  present  series,  I  have  received  from  Dr.  Rattermann,  late  of 
Tubingen,  an  essay,  written  by  himself,  in  which  this  question  is 
discussed  at  length,  and  the  repetition  of  abortion  upon  the  same 
individual,  in  the  early  months  of  pregnancy,  is  defended.  I  have 
carefully  considered  the  several  arguments  advanced  by  the  gentle- 
man, and  am  compelled  to  adhere  to  the  views  I  have  already 
expressed. 

"In  presenting  a  report  upon  the  matter,  in  1857,  by  direction 
of  the  Suffolk  District  Medical  Society  of  Massachusetts,  the  writer 
offered  the  draft  of  a  law,  prepared  after  much  thought  and  consul- 
tation, with  legal  as  well  as  with  medical  men,  and  embodying  the 
suggestions  made  above.  This  was  intended  for  the  consideration 
of  the  Legislature  of  the  State,  in  the  hope  that  it  might  be  of  aid 
toward  a  modification  of  the  present  defective  law. 

"  Having  seen  no  reason  to  change  the  opinion  then  avowed,  but 
on  the  contrary,  receiving  constant  confirmation  of  their  truth,  I 
now  present  the  essential  portions  of  that  draft,  acknowledging  most 
willingly  that  its  wording  may,  perhaps,  with  safety,  be  simplified 
and  condensed  ;  but  contending,  in  all  sincerity  and  earnestness  of 
purpose,  that  its  general  tenor  is  what  justice  and  humanity  alike, 
and  imperatively,  demand  at  the  hands  of  society. 

"  '  Whoever,  with  intent  to  cause  and  procure  the  miscarriage  of 
a  woman,  shall  sell,  give,  or  administer  to  her,  prescribe  for  her,  or 
advise,  or  direct,  or  cause,  or  procure  her  to  take  any  medicine,  or 
drug,  or  substance  whatever,  or  shall  use,  or  employ,"  or  advise  any 
instrument,  or  other  means  whatever,  with  the  like  intent,  unless 
the  same  shall  have  been  necessary  to  preserve  the  life  of  such 

*  Loc.  cit.,  article  317. 


JURISPRUDENCE  OF  ABORTION.         337 

woman,  or  of  her  unborn  child,  and  shall  have  been  so  pronounced 
(in  consultation)  by  two  competent  physicians  ;  and  any  person,  with 
the  like  intent,  knowingly  aiding  and  assisting  such  offender  or 
offenders,  shall  be  deemed  guilty  of  felony,'  etc.  etc. ;  '  and  if  such 
offence  shall  have  been  committed  by  a  physician,  or  surgeon,  or 
person  claiming  to  be  such,  or  by  a  midwife,  nurse,  or  druggist,  such 
punishment  may  be  increased  at  the  discretion  of  the  court. 

"  '  Every  woman  who  shall  solicit,  purchase  or  obtain  of  any  per- 
son, or  in  any  other  way  procure,  or  receive,  any  medicine,  drug,  or 
substance  whatever,  and  shall  take  the  same,  or  shall  submit  to  any 
operation  or  other  means  whatever,  or  shall  commit  any  operation  or 
violence  upon  herself,  with  intent  thereby  to  procure  a  miscarriage, 
unless  the  same  shall  have  been  by  two  competent  physicians  (in 
consultation)  pronounced  necessary  to  preserve  her  own  life,  or  that 
of  her  unborn  child,  shall  be  deemed  guilty,'  etc.  etc. ;  '  and  if  said 
offender  be  a  married  woman,  the  punishment  may  be  increased  at 
the  discretion  of  the  court.' 

"  It  was  also  advised  that  the  encouragement  of  criminal  abortion, 
by  publication,  lecture  or  otherwise,  or  by  the  advertisement,  sale, 
or  circulation  of  such  publication,  should  be  made  penal,  and  that  the 
present  well-worded  statute  against  the  personal  advertisements  of 
abortionists,  and  their  nostrums,  should  be  rigorously  enforced. 

"  To  the  words  now  quoted  were  added,  and  they  are  still  applica- 
ble, the  following  : 

"  '  We  have  aimed  at  a  statute,  which,  while  it  better  defined  this 
atrocious  crime,  and  covered  the  usual  grounds  of  escape  from  con- 
viction, established  also  the  proper  standard  of  competence  in  all 
medical  questions  involving  issues  of  life  and  death.  "We  believe 
that  it  would  be  the  means  of  preventing  much  of  the  present  awful 
waste  of  human  life.  But  enforce  such  a  law,  and  the  profession 
would  never  allow  its  then  high  place  in  the  community  to  be  un- 
worthily degraded  ;  nor,  as  now,  would  those  be  permitted,  unchal- 
lenged, to  remain  in  fellowship,  who  were  generally  believed  guilty, 
or  suspected  even  of  this  crime.'* 

*  Report  to  Suffolk  District  Med.  Society,  May,  1857,  p.  12. 


22 


GENERAL   INDEX. 


Abortion,  statistics  of,  19 
"         causes  of,  31 
"         treatment  of,  153 
"         of  animals,  108 
"         forceps,  288 
"         vectis,  245 

Actual  symptoms  of  abort'n,  124 

Actea  alba,  a  cause  of    "      92 

Acids  in  treatment  of  anaemia, 

160 

Acetic   acid  as  a  preventive  of 
conception,  305 

Aconite  in  treatment  of   abor- 
tion, 220 

Aconite  as  a  preventive  of  con- 
ception, 306 

Adhesion,  treatment  of,  253 

Aloes,  a  cause  of  abortion,  92 

Aletris  farinosa  a  cause  of  abor- 
tion, 93 

Aletris  farinosa  in  treatment  of 
abortion,  222 

Alum  as  a  preventive   of  con- 
ception, 305 

Alkalies  as  a  preventive  of  con- 
ception, 305 

Alabama,  laws  of,  on  abort'n,  330 

Anaemia,  a  cause  of  abortion,  35 
"        treatment  of,  154 

Anteversion,   a  cause  of    abor- 
tion, 84 

Anteversion,  treatment  of,  214 

Appearance  on   examination  of 
cervix  uteri,  83 

Apis  mellifica,  a  cause  of  abor- 
tion, 91 

Arnica   in    treatment  of    abor- 
tion, 218 


Asarum  europeum,   a   cause  of 

abortion,  92 
Asarum  canadense,  a  cause   of 

abortion,  93 
Asclepias  incarnata,  a  cause  of 

abortion,  93 
Asclepias    sjriaca,   a   cause   of 

abortion,  93 
Astringents   as    preventives   of 

conception,  306 
Atrophy  of  placenta,  a  cause  of 

abortion,  44 


Baptisia  tinctoria,  a  cause  of 
abortion,  94 

Belladonna  in  treatment  of  abor- 
tion, 220 

Belladonna  as  a  preventive  of 
conception,  306 

Blows,  Treatment  of,  189 

Blunt  hook,  229 

Borax,  a  cause  of  abortion,  94 

Bovista,  a        "  "         95 


Calcareous  degeneration  of  pla- 
centa, a  cause  of  abortion,  44 

Calcareous  degeneration  of  pla- 
centa, treatment  of,  175 

California,  laws  of,  on  abortion, 

324 

Caoutchouc  bags,  271 

Can    abortion  be  controlled  by 
law,  332 


340 


GENERAL    INDEX. 


Case  of  retroversion  of  the  ute- 
rus, 257 

Causes  of  abortion,  33 

Cancerous  ulcer,  a  cause  of  abor- 
tion, 80 

Cantharis,  a  cause  of  abortion,  96 

Caulophyllin,  a  cause  ofab'n,  96 
"  in  treatment  of  abor- 

tion, 220 

Cerebro-spinal  meningitis, a  cause 
of  abortion,  49 

Centric  causes  of  abortion,  45 
"       causes,  treatment  of,  176 

Cervical  leucorrhoea,  a  cause  of 
abortion,    44 

Chancre  simplex,  treatment  of, 

208 

Cholera  as  a  cause  of  abortion,  39 

Cholera,  treatment  of,  170 

Chlorosis,  treatment  of,  159 

Cimicifuga  racemosa,  a  cause  of 
abortion,  97 

Cimicifuga   racemosa    in    treat- 
ment of  abortion,  220 

Cinnamon  in  treatment  of  haem- 
orrhage, 221 

Classification  of  States  according 
to  Jaws,  326 

Cold  water  in  treatment  of  ab- 
ortion, 226 

Common  salt  as  a  preventive  of 
conception,  305 

Complications     occurring    with 
abortion,  131 

Congestion   of  the   placenta,   a 
cause  of  abortion,  43 

Congestion  of  the  uterus,  a  cause 
of  abortion,  61 

Congestion  of  the  uterus,  treat- 
ment of,  191 

Congestion  of  the  ovaries,  a  cause 
of  abortion,  90 

.Concentric  causes  of  abortion,  49 

Concentric  causes,  treatment  of, 

178 

Coitus  as  a  cause  of  abortion,  87 

Corroding  ulcer,  a  cause  of  abor- 
tion, 80 

Corpulence,  treatment  of,  157 

Constipation,  treatment  of,    186 


Colpeurynteur  in    treatment   of 

abortion,   226 

Colpeurynteur  to  produce  abor- 
tion, 273 

Condom,  description  and  use  of, 

298 

Concealment  of  births  and  deaths, 

332 

Conduct  of  physicians  when  call- 
ed to  case  of  abortion,  234 
Connecticut,  laws  of,  on  abor- 
tion, 323 

Criminal  abortion  considered,  313 

"  "    is  it  increasing,  18 

"  '.'     its  jurisprudence, 

320 

Cystitis,  treatment  of,  186 


Danger  from  use  of  stillette,  270 
Date  of  viability  of  foetus,  117 
Death  of  the  embryo,  a  cause  of 

abortion,  87 

Decidua,  character  of,  116 
Decodon  verticillatus,  a  cause  of 

abortion,  99 

Definition  of  abortion,  36 
Dental  causes  of  abortion,  56 

"  treatment  of,  180 

Diagnosis  of  abortion,  133 

"  "         after  fourth 

month,  139 

Diarrhoea,  treatment  of,  185 
Diameters  of  child's  head,  265 

"  pelvis,  266 

Dimensions  of  fcetus  at  different 

periods,  119 

Dietetic  treatm't  of  abortion,  251 
Direct  blows  upon  brain,  treat- 
ment of,  177 

Diphtheria,  treatment  of,  168 
Discharges  after  abortion,  131 
Displacements  of  the  uterus,  a 

cause  of  abortion,  84 
Douche,  in   treatment   of  abor- 
tion, 273 

Dropsy  of  the  ovaries,  a  cause  of 
abortion,  90 


GENERAL   INDEX. 


341 


Dropsy  of  the  ovaries,  treatment 

of,  254 
Dry    cupping   in    treatment    of 

abortion,  233 
Draft  of  abortion  law,  by  Doctor 

Storer,  336 
Duty   of    physician    concerning 

prevention  of  conception,  291 
Dysmenorrhoea,  diagnosis  of,  135 
Dysentery  "  135 

"         treatment  of,  183 


Embryonic  abortion,  283 
Emotional  causes  of  abortion,  45 
"  treatment  of,  176 

Engorgement  of  the  cervix  uteri, 

192 
England,  laws  of,  on  abortion, 

321 

Epilepsy,  treatment  of,  189 
Ergot,  as  a  cause  of  abortion,  47 
Essex  syringe,  203 
Exanthematous    fevers    causing 
abortion,  38 


Falls,  treatment  of,  189 

Fatty  deterioration  of  chorion 
and  placenta,  a  cause  of  abor- 
tion, 41 

Fatty  deterioration  of  chorion 
and  placenta,  treatment  of,  1 74 

Fecundity  in  European  countries, 

20 

Foetus,  when  so  named,  121 
"        date  of  viability  of,  117 
"        weight  and  length  of,  at 
different  periods,  119 

Foetal  abortion,  when  necessary, 
'       279 

Ferrum  in  Anaemia,  160 

Fevers,  yellow,  39 

"         exanthematous,  38 

Fissured  ulcer,  a  cause  of  abor- 
tion, 77 


Fissured  ulcer,  treatment  of,  205 

Fissure  of  the  anus,  185 

Fistulas,  treatment  of,  253 

First  stage  of  labor,  management 
of,  244 

Flexible   bougie,   manipulations 
with,  280 

Flexible  catheter,  manipulations 
with,  284 

Follicular  ulcer,  a  cause  of  abor- 
tion, 79 

Follicular  ulcer,  treatment  of,  206 

Forceps,  long,  231 
"      '  short,  231 

French  laws  on  abortion,  322 

Frequency  of  "          22 

Fucus  vesiculosis  in  corpulence, 

158 

Functional    diseases    of    uterus, 
causes  of  abortion,  61 

Functional    diseases    of    uterus, 
treatment  of,  191 


Galvanism,  a  cause  of  abortion,  48 
"  in  treatm't  of  "  233 
11  to  induce  "  277 

Gastric  irritation,  a  cause  of  ab- 
ortion, 56 

Gastric  irritation,  treatm't  of,  182 
Gelseminum  in  treatment  of  ab- 
ortion, 221 

Gelseminum  to  prevent  concep- 
tion, 306 
Generation,  115 
Germany,  laws  of,  on  abortion, 

322 
Gonorrhoea,  a  cause  of     ;<       69 

"  treatment  of,  197 

Granular  vaginitis,  treatment  of, 

188 


Habitual  abortion,  59 

Haemorrhage,  diagnosis  from  ab- 
ortion, 137 

Haemorrhage,  after  sixth  month, 
treatment  of,  239 


342 


GENERAL   INDEX. 


Haemorrhoids,  treatment  of,  185 

Hot  water  in  treatment  of  abor- 
tion, 227 

How  to  use  stillette,  269 

"      destroy  spermatozoa,  299 
"      render  laws  efficient,  334 

Hydatids,  a  cause  of  abortion,  41 
"         treatment  of,  175 

Hydrorrhoea,  diagnosis  from  ab- 
ortion, 137 

Hypertrophy  of  placenta,  a  cause 
of  abortion,  44 

Hypertrophy  of  the  uterus,  treat- 
ment of,  253 

Hypertrophy    of  cervix,    symp- 
toms of,  183 

Hypertrophy   of    cervix,    treat- 
ment of,  192 

Hysteria,  treatment  of,  189 


Ice  in  treatment  of  abortion,  226 

Illinois,  laws  of,  on       "        324 

Ilex  opaca,  a  cause  of  "         100 

Impregnation,  293 

Indiana,  laws  of,  on       "        331 

Induration  of  the  cervix,  a  cause 
of  abortion,  82 

Indurated  chancre,  treatment  of, 
208 

Inflammation  of  placenta,  a  cause 
of  abortion,  43 

Inflammation  of  ovaries,  a  cause 
of  abortion,  90 

Inflammation  of  mammae,  treat- 
ment of,  253 

Injections,  288 

"          when  to  use,  307 

Instrumental  irritation,  a  cause 
of  abortion,  88 

Intra  uterine  syringe,  275 

Iowa,  laws  of,  on  abortion,  324 

Irregularity  of  os  uteri,  treat- 
ment of,  200 

Italy,  laws  of,  on  abortion,  323 


Jewish  customs,  294 


Jumping,  treatment  of  injuries 

from,  189 
Jurisprudence  of  abortion,  320 


Kansas,  laws  of,  on  abortion,  331 


Laudanum  in  treatment  of  abor- 
tion, 222 

Laws  of  the  Shastras  on  abortion, 

320 

Laws  of  foreign  countries  on  ab- 
ortion, 321 

Laws  of  different  States  on  abor- 
tion, 323 

Lecture  on  criminal  abortion- 
Prof.  A.  E,  Small,  313 

Lecture  on  jurisprudence  of  abor 
tion — Prof.C.Woodhouse,  320 

Length  of  foetus  at  three  to  seven 
weeks,  119 

Length  of  foetus  at  two  to  five 
months,  120 

Length  of  foetus  at  six  months 
to  full  term,  121 

Leucorrhoea,  a  cause  of  abortion, 

62 

Leucorrhcea,  cervical,  a  cause  of 
abortion,  64 

Leucorrhcea,  vaginal,  a  cause  of 
abortion,  67 

Leucorrhcea,  treatment  of,  192 

Leucorrhoea,  cervical,  treatment 
of,  192 

Leucorrhcea,  vaginal,   treatment 
of,  194 

Leucorrhcea,  sequelae,  treatment 
of,  65 

Local  causes  of  abortion,  39 
"     diseases,  treatment  of,  171 
"     syphilis,  symptoms  of,    81 

Louisiana,  laws  of,  on  abortion, 

330 


Maine,  laws  of,  on  abortion,  327 
Malformation  of  the  ovum,  172 


GENERAL    INDEX. 


343 


Malformation  of  the  membranes, 

172 

Mammary  irritation,  a  cause  of 
abortion,  56 

Mammary    irritation,    treatment 
of,  179 

Management  of  labor,  241     . 

Manner   of    coition    to   prevent 
conception,  294     . 

Manchester   Lying-in    Hospital, 
statistics  of,  23 

Massachusetts,  statistics  of,  on 
abortion,   22 

Massachusetts,  laws  of  on  abor- 
tion, 324 

Means  employed  to  destroy  sper- 
matozoa, 304 

Mechanical   abortion,   pathology 
of,  142 

Mechanical  obstruction,  265 

"  treatment  of  sequelae 

of  abortion,  256 

Medicinal  causes  of  abortion,  46 
"  "     treatment  of,  178 

"        treatm'tofabort'n,  217 
"  "         in  the  third 

.    stage,  252 

Medicines    acting    as    predispo- 
nents  to  abortion,  91 

Medicines      acting     as     centric 
causes  of  abortion,  91 

Medicines  acting  as   concentric 
causes  of  abortion,  91 

Membranes,  how  separated  from 
uterus,  274 

Membranes,    how   separated   by 
air,  276 

Menstrual  crisis,  a  cause  of  abor- 
tion, 36 

Menstrual  crisis,  treatm't  of,  162 

Mental    aberrations,    treatment 
of,  254 

Menorrhagia,  chronic,  treatment 
of,  255 

Mercurialization,  a  cause  of  ab- 
ortion, 38 

Mercurialization,  treatm't  of,  164 

Mercury,  a  cause  of  abort'n,  101 

Methods  of  inducing  premature 
labor,  269 


Methods  of  inducing  embryonic 

abortion,  284 

Methods  of  using  syringe,  308 
Metritis,  diagnosis  from  abortion, 

134 
Metritis,  treatment  of,  200 

"          puerperal,    treatment 
of,  254 

Missouri,  laws  of,  on  abort'n,  324 
Minnesota,  laws  of,  on  "  327 
Michigan,  laws  of,  on  "  329 
Moles  as  causes  of  abortion,  40 

"       treatment  of,  175 
Muriatic  acid,  to  destroy  sperm- 
atozoa, 306 


Neuralgia  of  ovaries,  treatment 
of,  312 

New  Hampshire,  laws  of,  on  ab- 
ortion, 328 

New  York,  laws  of,  for  abortion, 

323 

New  York,  statistics  of  abor'n,  20 

a  it  tl 

from  1804  to  1862,  21 

New  York,  ratio  in,  21 

Nitric  acid,  to  prevent  concep- 
tion, 306 

Non-medical  fluids,  use  of,  307" 

Nux  vomica,  to  prevent  concep- 
tion, 305 


Obstetric  abortion,  263 
Obesity,  a  cause  of  abortion,  35 
Occurrence  of  abortion,  tabular 

view,  26 

Ohio,  laws  on  abortion,  323 
Opium,  to  prevent  concept'n,  305 
Organic    diseases    of   uterus,    a 

cause  of  abortion,  71 
Organic    diseases    of    placenta, 

treatment  of,  173 
Ovarian  causes  of  abortion  : 

Irritation,  35 


344 


GENERAL    INDEX. 


Congestion,  58 
Inflammation,  90 
Tumors,  90 
Dropsy,  90 
Ovarian  diseases,  treatm't  of,  211 


irritation, 
"     tumors, 
Ovaritis, 
Ovaralgia, 
Ovular  abortion, 


Ovum,  115 


211 

212 
212 
212 
290 

when  necessary, 
290 


Paris,  statistics  of.  on  abort'n,  20 

Pathology  of  "      142 

Parotidean  irritation,  a  cause  of 
abortion,  55 

Parotidean   irritation,  treatment 
of,  178 

Paralysis,  treatment  of,  256 

Patient,  examination  of,  237 
"       position  of,  243 

Pelvic  diameters,  266 

"       cellulitis,  treatm't  of,  253 

Peritonitis,  diagnosis  from  abor- 
tion, 135 

Period  of  pregnancy  at  Avhich  ab- 
ortion is  most  frequent,  25 

Period  of  occurrence  of  abortion, 
tabular  view,  26 

Period  of  abortion,  tabular  view, 

309 

Pessaries,  a  cause  of  abortion,  88 
"         ring,  259 

Podophyllum,  a  Cjause  of  abort'n, 

102 

Position  of  patient  during  injec- 
tions, 308 

Postural  treatm't  of  abort'n,  248 

Post  partum     "  "  248 

Phagsedenic  ulcer,  a  cause  of  ab- 
ortion, 80 

Phagtedenic  ulcer,  treatment  of, 

206 

Phlebitis,  treatment  of,  254 

Physician's  duty  when  applied  to 
to  produce  abortion.  318 


Physical  causes  of  abortion,  45 
Physiology  of  generation,  115 
Plethora,  a  cause  of  abortion,  35 

"         treatment  of,  155 
Placental  causes  of  abortion  : 
Fatty  degeneration,  42 
Congestion,  43 
Inflammation,  43 
Calcareous  degeneration,  44 
Tubercular  deposits,  44 
Atrophy,  44 
Hypertrophy,  44 
Previa.  44 
Placental  fatty  degeneration, 

treatment  of,  174 
Placental   calcareous    degenera- 
tion, treatment  of,  175 
Placenta  previa,  treatment  of, 

172 

"  retention  of,  140 

Predisposing  causes  of  abortion, 

35 

"  treatment  of,  155 

Pregnancy,  signs  of,  133 
Premature  labor,  263 

"  when  necessary, 

264 

Premonitory  symptoms  of  abor- 
tion, 133 

Preventive    treatment    of   abor- 
tion, 155 
Principal  medicines  as  causes  of 

abortion,  91 
Prognosis  of  abortion,  148 

"         when  favorable,  148 
"  "     unfavorable, 150 

Prolapsus,  a  cause  of  abortion,  84 
"         treatment  of,  213 
"         mechanical  treatment 
of,  256 
Puerperal  Peritonitis,  treatment 

of,  254 

Puerperal  Metritis,  treatment  of, 

254 

Pulsatilla  in  treatment  of  abor- 
tion, 222 


Quinine,  a  cause  of  abortion,  46 


GENEKAL    INDEX. 


345 


Quinine  sulphas,  a  cause  of  ab- 
ortion, 103 


Ratio  of  abortion  in  N.  York,  21 
Rectal  irritation,  a  cause  of  ab- 
ortion, 57 

Rectal  irritation,  treatm't  of,  183 
Reflex  causes  of  abortion,  44 

"  "       treatment  of,  176 

Regulation  of  coition,  294 

"  "  Jewish 

custom,  294 

Register  at  the  Morgue,  333 
Remote  consequences  of  abortion, 

151 

Remedial  treatment  of  abortion, 

217 

Renal  causes  of  abortion,  57 
Results  of  abortion,  28 
Resume  of  treatment,  209 
Retention  of  ovum,  a  cause  of 

abortion,  140 

Return  of  menses,  a  cause  of  ab- 
ortion, 36 

Return  of  menses,  treatment  of, 

162 

Retroversion,  a  cause  of  abortion, 

84 

treatment  of,  214 
"  mechanical    treat- 

ment of,  256 

Rules  for  use  of  blunt  hook,  228 
Ruta  graveolens,  a  cause  of  ab- 
ortion,  103 

Ruta  graveolens,  treatment  of, 

221 


Sabina,  a  cause  of  abortion,  104 
"       in  treatment  of    "     221 
Sanguinaria,  a  cause  of  ab'n,  109 
Sarracenia  purp.,  166 
Scarlatina,  treatment  of,  166 


Scotland,  laws  of,  on  abort'n,  322 
Scrofulous  diathesis,  a  cause  of 

abortion,  36 
Scrofulous    diathesis,   treatment 

of,  162 

Secale  corn.,  a  cause  of  ab'n.  106 

"          "     in  treatm't  of  "   221 

Separation  of  membranes    from 

uterus,  274 
Separation    of  membranes  from 

uterus  by  air,  276 
Sequelae  of  leucorrhoea.  a  cause 

of  abortion,  65 
Sequelae  of  abortion,  131 

"  "        248 

Shastras,  laws  of,  on  abort'n.  320 
Simple    irritation  of  ovaries,  a 

cause  of  abortion,  89 
Simple  granulating  ulcer,  treat- 
ment of,  204 

Softening  of  the  uterus,  200 
Sponge  tent,  271 

"     in  treatment  of  abor'n,  225 
Spermatozoa,  character  of.  298 

"  how  destroyed,  299 

Spirits  of  wine,  to  prevent  con- 
ception, 305 

Stage  of  pregnancy,  first,  244 
"  "  "    sequelae 

of,  249 

Stage  of  pregnancy,  second,  246 
11  "  "     sequela? 

of,  249 

Stage  of  pregnancy,  third,  247 
"  "  "    sequela? 

of,  250 

Statistics  of  abortion,  19 
in  foreign  countries,  20 
in  New  York,  20 
in  Boston,  22 
iu  Massachusetts.  22 
in  Chicago,  22 
Manchester   Lying-in    Hos- 
pital, 24 

at  the  Morgue,  28 
States,  laws  of,  on  abortion.  323 
which  have  no  laws  on  ab- 
ortion, 325 

which  acknowledge  the  crime 
after  quickening,  32G 


346 


GENERAL    INDEX. 


which      acknowledge      the 
crime,  but  require  proof 
of  pregnancy,  326 
which  punish  an  attempt  at 

abortion,  326 
Stillette,  description  of,  270 

"       death  by,  270 
Strychnine,  a  cause  of  ab'n,  47 

"      to  prevent  concept'n,  305 
Sucking  pumps,  to  induce  abor- 
tion, 275 

Sulphate  of  zinc,  to  prevent  con- 
ception, 306 

Sulphuric  acid,   in  abortion,  223 
"  "       to  prevent  con- 

ception, 305 
Swelling  of  cervix,  200 
Syringe,  Essex,  as  a  means  to 

prevent  conception,  307 
Symptoms  of  induration,  83 
"  retroversion,  86 

"  abortion,  122 

Syphilis,  a  cause  of  abortion,  37 

"         sterility, 
treatment  of,  163  38 

ulcerat'n,  a  cause  of  ab'n,  80 
"          treatment  of,  208 
constitu'al,  cause  of  ab'n-,  81 
local,  "  "     81 


Table  showing  frequency  of  ab- 
ortion, 26 

Tabular  view  of  the  three  great 
periods  of  utero-gestation,  309 

Tampon,  its  use  in  abortion,  224 

Tanacetum  vulgans,  a  cause  of 
abortion.  111 

Terebinth,  a  cause  of  abort'n,110 

Texas,  laws  of,  on          "       330 

Third  stage  of  pregnancy,  abor- 
tion at,  247 

Third  stage  of  pregnancy,  abor- 
tion at,  sequelae,  250 

Thyroidal  causes  of  abortion,  56 
"  treatment  of,  1 79 

Treatment  of  abortion,  155 


Tubercular  deposits  in  placenta, 
a  cause  of  abortion,  44 


Ulceration  of  the  cervix,  a  cause 

of  abortion,  71 

Ulceration  of  the  cervix,  treat- 
ment of,  198 

Ulcer,  varicose,  cause  of  ab'n,  76 

"        treatment  of,-  204 

fissural,  a  cause  of  ab'n,  77 

"       treatment  of,  205 
follicular,  a  cause  of  ab'n,  79 

"       treatment  of,  206 
corroding,  a  cause  of  ab'n,  80 
calcareous,       <(  "     80 

syphilitic,        "  «     81 

"  treatment  of,  208 

Unnecessary  abortion,  murder, 

313 

Uterine  causes  of  abortion,  59 
"      displacements,  treatment 
of,  212 

Utopian  theories,  291 
Uterine  sound,  289 
Use  of  speculum,  a  cause  of  abor- 
tion, 73 

Ustilago  niadis,  a  cause  of  abor- 
tion, 112 


Vaginitis,  a  cause  of  abort'n.  58 

"  treatment  of,  187 

"     vesicular,     "  188 

"     granular       "  188 

Vaginal  irritation,    "  187 

"     leucorrhcea,    "  194 

"  a  cause  of 

abortion,  67 

Vaginismus,  a  cause  of  abor'n.  50 

"  treatment  of,  189 

Variola,  "  164 

"     a  cause  of  abortion,  38 
Variation  of  period  of  quicken- 
ing, 316 


GENERAL    INDEX. 


347 


Vesical    irritation,    a   cause   of 

abortion,  57 

Vesical  irritat'n,  treatm't  of,  186 
Vermont,  laws  of,  on  abort'n,  329 
Virginia,  "  "  324 

Vomiting,  a  cause  of  abort'n,  266 


"Weight   of  fcetus,   at   three  to 

seven  weeks,  119 
"Weight  of  fcetus,  at  two  to  five 

months,  120 


Weight  of  fcetus,  at  six  months 

to  full  term,  121 
Wisconsin,  laws  of,  on  ab'n,  329 


Yellow  fever,  a  cause  of  ab'n,  39 


Zymotic    diseases,    a   cause    of 
abortion,  37 


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Hale:   Systematic  treatise  on 
abortion 


